Peritoneal Fluid and Plasma Fibrinolytic Activity in Women with Pelvic Inflammatory Disease

1992 ◽  
Vol 68 (02) ◽  
pp. 102-105 ◽  
Author(s):  
P J Dörr ◽  
E J P Brommer ◽  
G Dooijewaard ◽  
H M Vemer
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Peritoneal Fluid ◽  
Fibrinolytic Activity ◽  
Degradation Products ◽  
Adhesion Formation ◽  
High Rate ◽  
Control Group ◽  
The Difference ◽  
Fibrinolytic Parameters

SummaryPrevious studies have shown that the fibrinolytic activity of peritoneum is depressed in local inflammation. We measured fibrinolytic parameters in peritoneal fluid and in plasma of 10 women with pelvic inflammatory disease (PID). Nine women, in whom laparoscopy for sterilisation was performed, served as a control group.In the peritoneal fluid of women with PID, PAI-Ag, t-PA-Ag and u-PA-Ag were many times higher than in the control group. In contrast to the antigens which may be present in inert complexes, the potentially active compounds, measured as t-PA activity and plasmin-activable scu-PA, were not significantly different in the two groups, and in none of the samples was the active enzyme tcu-PA detectable. Nevertheless, the mean peritoneal fluid TDP and FbDP concentrations were about twenty times higher in the PID group than in the control group. In plasma of PID patients, none of the parameters except u-PA-Ag differed from those in the control group. The difference between control and patient plasma u-PA-Ag was statistically significant, but too small to attach any relevance to the observation.Our data suggest that, in contrast to the classical concept of decreased fibrinolytic activity as a cause of adhesion formation, intraperitoneal fibrinolysis is enhanced in peritoneal inflammation through stimulation of the local production of t-PA and u-PA. Despite concomitant production of PAI, fibrinolysis occurs at a high rate, resulting in high levels of fibrin degradation products. Since this activated fibrinolysis does not meet the demand, therapeutic enhancement should be considered to prevent adhesions.

Short-term Effect of Surgical Trauma on Rat Peritoneal Fibrinolytic Activity and Its Role in Adhesion Formation

2000 ◽  
Vol 84 (11) ◽  
pp. 876-881 ◽  
Author(s):  
G. C. M. Trimbos-Kemper ◽  
E. A. Bakkum ◽  
J. B. M. Z. Trimbos ◽  
P. J. Declerck ◽  
T. Kooistra ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Peritoneal Fluid ◽  
Fibrinolytic Activity ◽  
Peritoneal Lavage ◽  
Degradation Products ◽  
Adhesion Formation ◽  
Surgical Trauma ◽  
Fibrin Deposition ◽  
Fibrinolytic Parameters ◽  
Pai 1

SummaryFibrin deposition, the primary step in the formation of post-surgical adhesions, is the result of a disbalance between the fibrinforming and the fibrin-dissolving capacity of the peritoneum. Literature data suggest a transient reduction in local plasminogen activator activity after peritoneal trauma, which results in a reduction of fibrinolysis and permits deposited fibrin to become organized into fibrous, permanent adhesions. In the present study, the fibrinolytic parameters tissue-type plasminogen activator (tPA; antigen and activity) and plasminogen activator inhibitor type-1 (PAI-1; antigen and activity) were measured in peritoneal fluid, in peritoneal biopsies and in plasma to establish the time course of changes in fibrinolytic activity.A standardized peritoneal adhesion model in the rat.Analysis, over a 72-h period following surgical trauma, of the main fibrinolytic parameters in peritoneal lavage, in biopsies of damaged and undamaged peritoneum, and in plasma, and determination of fibrin and fibrin(ogen)-degradation products in peritoneal lavage fluid.At all time intervals, tPA antigen was found to be about six-fold increased in peritoneal lavage after surgical trauma. This significant rise in tPA antigen was accompanied by a large increase in its main inhibitor PAI-1, resulting in tPA activity levels similar to, or slightly higher than, those found in control animals. tPA activity was lowest at 4 h and increased thereafter. Also in biopsies from damaged peritoneum, tPA antigen was significantly increased. Tissue tPA activity was also lowest at 4 h, after which it increased, significantly so at 24 and 72 h. Similar, though smaller, changes were seen in the biopsies from undamaged areas of the peritoneal wall in operated rats. PAI-1 (antigen and activity) was not detected in peritoneal biopsies. Fibrin-related material (especially fibrin monomer/fibrinogen, an indicator of forming fibrin) in peritoneal fluid was slightly increased at 4 h, and abundantly present at 16 and 24 h, returning to control levels at 72 h. Fibrin degradation products were always present. From 2 h onward, adhesions were found.In contrast to the view that adhesions are formed as a result of a reduced fibrinolytic activity, our results demonstrate that tPA activity remained unchanged or slightly increased after surgical trauma, and point to increased fibrin formation rather than diminished fibrinolytic activity as the main cause of fibrin deposition after peritoneal trauma. Therapies directed at prevention of adhesion formation should therefore aim at avoiding massive fibrin production and at promoting fibrinolytic activity during the early period after trauma.

Parameters of Fibrinolysis in Peritoneal Fluid and Plasma in Different Stages of the Menstrual Cycle

1993 ◽  
Vol 70 (05) ◽  
pp. 873-875 ◽  
Author(s):  
P J Dörr ◽  
E J P Brommer ◽  
G Dooijewaard ◽  
H M Vemer
Keyword(s):  
Menstrual Cycle ◽  
Peritoneal Fluid ◽  
Fibrinolytic Activity ◽  
Adhesion Formation ◽  
Healthy Individuals ◽  
Increased Risk ◽  
Ovulatory Period ◽  
Fibrinolytic Parameters ◽  
Fibrinolytic Capacity ◽  
Pai 1

SummaryThe purpose of this study was to investigate differences in fibrinolytic activity in peritoneal fluid and plasma of women in the first and second part of the menstrual cycle. Given the classic concept of decreased fibrinolytic activity as a cause of adhesion formation, and if such differences are found, the stage of women’s menstrual cycle should be taken into consideration when scheduling a laparotomy.We measured fibrinolytic parameters in peritoneal fluid and plasma in eight women in the pre-ovulatory period and in eleven women in the post-ovulatory period of the menstrual cycle.There were no differences in t-PA-Ag, t-PA-Act, u-PA-Ag and scu-PA concentrations in peritoneal fluid between the pre- and post-ovulatory group. Nevertheless, PAI-1-Ag in peritoneal fluid was three-fold higher in the post-ovulatory phase (p <0.02). In peritoneal fluid the concentrations of both TDP and FbDP were three-fold higher at the same phase (p ≥0.05).Plasma u-PA-Ag and scu-PA concentrations were significantly lower (30%, p <0.05) in the post-ovulatory phase and also lower than plasma u-PA-Ag and scu-PA (measured with the same assay) in a group of 50 healthy individuals. No differences in t-PA and PAI concentration were found.In conclusion, the intraperitoneal fibrinolytic capacity might be impaired in the second part of the menstrual cycle, regarding the elevated levels of PAI-1-Ag, leading to an increased risk for postovulatory adhesion formation. The low plasma u-PA-Ag and scu- PA levels post-ovulatory may have clinical relevance.

scholarly journals Bali Belly: Salmonella senftenberg Found in an Infected Ovarian Endometrioma

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
P. D. M. Pathiraja ◽  
Junaid Rafi ◽  
Emily Woolnough ◽  
Anna Clare
Keyword(s):  
Septic Shock ◽  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Antibiotic Treatment ◽  
Bacterial Translocation ◽  
Inflammatory Disease ◽  
Peritoneal Fluid ◽  
Ovarian Endometrioma ◽  
Surgical Evacuation ◽  
Salmonella Senftenberg

Salmonella is an extremely rare cause of an infected endometrioma. We present a case of a 30-year-old immunocompetent woman presenting with fevers and abdominal pain, on a background of prior endometriosis. Initial antibiotic treatment for pelvic inflammatory disease failed, and the patient progressed to septic shock requiring surgical evacuation of an infected ovarian endometrioma. Microbiological samples from stool, ovary, and peritoneal fluid revealed infection with Salmonella senftenberg. The likely diagnosis was Salmonella enterocolitis with bacterial translocation to an ovarian endometrioma.

Pelvic inflammatory disease associated with Chlamydia trachomatis but not Mycoplasma genitalium in New Zealand

Sexual Health ◽  
2016 ◽  
Vol 13 (1) ◽  
pp. 43 ◽  
Author(s):  
Jeannie Oliphant ◽  
Sunita Azariah
Keyword(s):  
New Zealand ◽  
Chlamydia Trachomatis ◽  
Sexual Health ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Trichomonas Vaginalis ◽  
Mycoplasma Genitalium ◽  
Control Group ◽  
Sexual Health Service ◽  
Relevant Variables

Background There is a paucity of studies looking at associations between Mycoplasma genitalium and pelvic inflammatory disease (PID). The objectives of this study were to estimate the prevalence of M. genitalium in women attending a sexual health service in New Zealand and secondly to examine for an association of M. genitalium with PID. Methods: Women consecutively attending the service for a sexual health screen (Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis) were recruited to establish a baseline prevalence of M. genitalium. An extra cervical swab was taken for the detection of M. genitalium. Recruitment of additional women with a clinical diagnosis of PID continued until a sufficient sample size was obtained to examine the association of PID with M. genitalium. Women in the baseline sample without PID were used as the control group. Results: The control group included 250 women, with M. genitalium diagnosed in 8.7% (95% CI 5.8–12.9%) and C. trachomatis in 9.9% (95% CI 6.8–14.2%). Ninety-one women were recruited with PID; M. genitalium was diagnosed in 9.9% (95% CI 5.3–17.7%) and C. trachomatis in 27.5% (95% CI 19.4–37.4%). Multivariate analysis using clinically relevant variables showed that a diagnosis of C. trachomatis (OR 2.44, 95% CI 1.24–4.81) but not M. genitalium (OR 0.91, 95% CI 0.38–2.20) was significantly associated with a PID diagnosis. Conclusions: M. genitalium was almost as commonly diagnosed as C. trachomatis in this population. C. trachomatis was the only infection that was significantly associated with PID.

Treatment of mild-to-moderate pelvic inflammatory disease with a short-course azithromycin-based regimen versus ofloxacin plus metronidazole: results of a multicentre, randomised controlled trial

2020 ◽  
pp. sextrans-2020-054468
Author(s):  
Gillian Dean ◽  
Suneeta Soni ◽  
Rachel Pitt ◽  
Jonathan Ross ◽  
Caroline Sabin ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Clinical Cure ◽  
Primary Outcome ◽  
Controlled Trial ◽  
High Rate ◽  
Resistance Testing ◽  
Short Course

ObjectiveA multicentre, randomised non-inferiority trial compared the efficacy and safety of 14 days of ofloxacin and metronidazole (standard-of-care (SoC)) versus a single dose of intramuscular ceftriaxone followed by 5 days of azithromycin and metronidazole (intervention arm (IA)) in women with mild-to-moderate pelvic inflammatory disease (PID).MethodsWomen with a clinical diagnosis of PID presenting at sexual health services were randomised to the SoC or IA arms. Treating clinicians and participants were not blinded to treatment allocation but the clinician performing the assessment of primary outcome was blinded. The primary outcome was clinical cure defined as ≥70% reduction in the modified McCormack pain score at day 14–21 after starting treatment. Secondary outcomes included adherence, tolerability and microbiological cure.ResultsOf the randomised population 72/153 (47.1%) reached the primary end point in the SoC arm, compared with 68/160 (42.5%) in the IA (difference in cure 4.6% (95% CI −15.6% to 6.5%). Following exclusion of 86 women who were lost to follow-up, attended outside the day 14–21 follow-up period, or withdrew consent, 72/107 (67.3%) had clinical cure in the SoC arm compared with 68/120 (56.7%) in the IA, giving a difference in cure rate of 10.6% (95% CI −23.2% to 1.9%). We were unable to demonstrate non-inferiority of the IA compared with SoC arm. Women in the IA took more treatment doses compared with the SoC group (113/124 (91%) vs 75/117 (64%), p=0.0001), but were more likely to experience diarrhoea (61% vs 24%, p<0.0001). Of 288 samples available for analysis, Mycoplasma genitalium was identified in 10% (28/288), 58% (11/19) of which had baseline antimicrobial resistance-associated mutations.ConclusionA short-course azithromycin-based regimen is likely to be less effective than the standard treatment with ofloxacin plus metronidazole. The high rate of baseline antimicrobial resistance supports resistance testing in those with M. genitalium infection to guide appropriate therapy.Trial registration number2010-023254-36.

Phosphatidvlcholine and Intraperitoneal Adhesions

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 77-78 ◽  
Author(s):  
Angelos Michael Kappas ◽  
Michael Fatouros ◽  
Kostas Siamopoulos ◽  
Manolis Mylonakis ◽  
Diamantis Cassioumis
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Wistar Rats ◽  
Adhesion Formation ◽  
Control Group ◽  
Intraperitoneal Adhesions ◽  
The Third ◽  
The Past ◽  
Before And After ◽  
The Difference

Phosphatidylcholine (PC), which has successfully been used in the past to increase ultrafiltration in continuous ambulatory peritoneal dialysis (CAPD) patients, has recently been found to prevent experimental adhesion formation after intraperitoneal irrigation with warm saline. The aim of this study was to determine the most effective route(s) of PC administration in the aforementioned model. Eighty Wistar rats underwent laparotomy and intraperitoneal irrigation with saline at 40°C, which in 20 rats was followed by closure of the abdomen (control group, Gc). In another 20 rats PC was given per os before and after irrigation (per os PC group, GoPc). In the third group PC was diluted in the irrigation fluid (intraperitoneal PC group, GIPC), and in the last group PC was given per os and intraperitoneally (combined PC group, Gcpc) Assessment of adhesions was performed 2 weeks after the irrigation. Adhesions were found in 12 rats in the Gc, 5 rats in the Gopc (p=0.05, Fisher's test), 17 rats in the GIPC, and 3 rats in the Gcpc (p=0.007, Fisher's test). The difference between Gopc and Gcpc was not statistically significant. The decreased adhesion formation after PC administration combined with the increased ultrafiltration may be of considerable importance in CAPD patients.

Sustained Fibrinolysis After Administration of t-PA Despite Its Short Half-Life in the Circulation

1987 ◽  
Vol 57 (01) ◽  
pp. 035-040 ◽  
Author(s):  
Paul R Eisenberg ◽  
Laurence A Sherman ◽  
Alan J Tiefenbrunn ◽  
Philip A Ludbrook ◽  
Burton E Sobel ◽  
...  
Keyword(s):  
Half Life ◽  
Fibrinolytic Activity ◽  
Degradation Products ◽  
Clinical Success ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Fibrin Degradation Products ◽  
Short Half Life ◽  
Type Plasminogen Activator ◽  
The Difference

SummaryTo characterize the duration of the fibrinolytic response to tissue-type plasminogen activator (t-PA) and streptokinase (SK) in patients with acute myocardial infarction we serially assayed crosslinked fibrin degradation products (XL-FDP) and Bβ15-42 fibrinopeptide. Use of specific monoclonal antibodies permitted quantification and differentiation of fibrin from fibrinogen degradation products. Marked elevations of XL-FDP occurred within 1 hour after administration of t-PA (n = 13) or SK (n = 35) to >1000 ng/ml in 79% of the patients. All patients given t-PA exhibited elevations of XL-FDP >1000 ng/ml, most exhibited values >5000 ng/ml (79% of patients). In contrast 6 of the patients given SK failed to exhibit XL-FDP >1000 ng/ml. XL-FDP >5000 ng/ml occurred in only 14%. The difference in the response to t-PA compared to SK was particularly striking 7 hours or more after administration of activator at which time XL-FDP were markedly elevated in patients given t-PA (5821 ± 1683 ng/ ml) compared with decreasing values in patients given SK (2924 ± 1186 ng/ml) (p <0.01). Levels of Bβ315-42 were significantly higher after t-PA compared with SK beginning 3 hours after treatment, consistent with a greater intensity of fibrinolytic response to t-PA. Marked elevations of this short lived degradation product of fibrin (t1/2 = 10-20 minutes) in the samples drawn late after administration of t-PA (44.3 ±12.8 nM) but not after SK (11.7 ± 4.5 nM) confirmed prolonged fibrinolytic activity of plasmin after t-PA. There was no discernible relationship between the extent of fibrinolysis as assessed by XL-FDP and Bβ 15-42 and the total dose of t-PA administered or the duration of the infusion. Elevations of XL-FDP invariably occurred after SK, and were not significantly different in patients with or without recanalization. Thus “clinical success” of coronary thrombolysis appears to depend on a favorable balance between thrombosis and fibrinolysis rather than the intensity of fibrinolysis alone. The prolonged fibrinolytic activity after t-PA appears to reflect the enhanced binding of this activator to fibrin and is likely to result in more sustained and hence more effective fibrinolysis with t-PA compared to SK despite the short half-life of t-PA (t1/2 = 6 minutes) in the circulation.

scholarly journals Clinical pathogenic basis for anti-adhesive treatment for appendicular-genital syndrome in women of reproductive age

2020 ◽  
Vol 3 (4) ◽  
pp. 228-232
Author(s):  
V.V. Simrok ◽  
◽  
I.A. Popova ◽  
D.V. Mel’nikova ◽  
◽  
...  
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Clinical Symptoms ◽  
Adhesion Formation ◽  
Fold Increase ◽  
Reproductive Age ◽  
Complex Treatment ◽  
Women Of Reproductive Age ◽  
Peritoneal Adhesions ◽  
Normal Ranges

Aim: to assess the efficacy of penicillamine for the complex prevention of pelvic peritoneal adhesions in appendicitis associated with the acute conditions of uterine appendages (appendicular-genital syndrome, AGS) based on the changes in the levels of hydroxyproline and the major clinical symptoms of pelvic inflammatory disease. Patients and Methods: 157 women of reproductive age with AGS who were urgently or routinely admitted to a gynecological or surgical hospital were examined. Comparison group women were prescribed with conventional anti-inflammatory treatment or surgery as needed. Study group women additionally received penicillamine 250 mg twice daily for a month. Pre- and post-treatment non-invasive assessment of the peritoneal adhesive process was performed by measuring the levels of protein-bound and free hydroxyproline. Treatment efficacy was evaluated after 1 month by the changes in hydroxyproline levels, major clinical symptoms, and ultrasound. Results: it was demonstrated that pelvic acute inflammatory disease results in > 1.5-fold increase in the levels of protein-bound and free hydroxyproline. Penicillamine as a component of the complex treatment for pelvic inflammatory disease reduces the levels of hydroxyproline to normal ranges. The changes in the major clinical symptoms and ultrasonic findings after penicillamine therapy were more significant compared to the standard treatment. Conclusions: penicillamine as a component of the complex treatment for pelvic inflammatory disease significantly accelerates the improvement of symptoms and remission as well as the formation of peritoneal adhesions. This prevents both pelvic adhesive disease and tubal- and peritoneal-factor infertility. KEYWORDS: appendicular-genital syndrome, inflammation, hydroxyproline, penicillamine, pelvic peritoneal adhesions, prevention, adhesion formation. FOR CITATION: Simrok V.V., Popova I.A., Mel’nikova D.V. Clinical pathogenic basis for anti-adhesive treatment for appendicular-genital syndrome in women of reproductive age. Russian Journal of Woman and Child Health. 2020;3(4):228–232. DOI: 10.32364/2618-8430- 2020-3-4-228-232.

scholarly journals A comparative study on the effects of various factors to the revalence of pelvic inflammatory disease in North central Nigeria

2021 ◽  
Vol 2 (2) ◽  
pp. 108-117
Author(s):  
U M Oyedum ◽  
F A Kuta ◽  
A A Saidu ◽  
H Babayi
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Reproductive Age ◽  
High Rate ◽  
North Central ◽  
High Prevalence ◽  
Tubal Blockage ◽  
Rural Dwellers ◽  
And Control ◽  
Gynaecological Disease

Pelvic inflammatory disease is a gynaecological disease that affects the upper genital organs of reproductive age females. It is a disease associated with clinical sequalae such as tubal blockage, oophoritis and cervicitis which are said to result to high rate of disease (such as female infertility) and deaths among the females. This study therefore attempts to evaluate the association of various factors to high prevalence of pelvic inflammatory disease among women residing in developing countries such as Nigeria. Questionnaires were administered to all women enrolled for this study too obtain their data. Seven hundred and twenty (720) patients out of 1170 patients enrolled for this study were recorded to be pelvic inflammatory disease patients, of which 380(85%) were rural dwellers; 452(87.6%) were ignorant of pelvic inflammatory disease and were thus easily prone to the disease; 285(86.4%) were within the reproductive ages of 25-29 years; 350(85.2%) previously had urinary tract infection a year ago; 496(85.8%) and 343(83.5%) were both married and uneducated females. The high prevalence of pelvic inflammatory disease recorded in this study is due to certain predisposing factors practiced among females in their reproductive ages, hence it is necessary for government to enforce certain measures such as establishment of free education, continuous awareness of pelvic inflammatory disease and establishment of free medical check up to help prevent and control the spread of pelvic inflammatory disease.

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