Summary
Revista Brasileira de Ginecologia e Obstetrícia. 12-04-2024;46:e-rbgo84
Included evaluation of the possibility of using the systemic inflammatory indices for preoperative screening for the presence and severity of endometriosis (EM) in comparison to the findings of the exploratory laparoscopy
88 women with clinical manifestations suggestive of EM were evaluated clinically and by US and gave blood samples for estimation of serum cancer antigen-125 (CA125), platelet and total and differential leucocytic counts for calculation of inflammatory indices; the Systemic Immune-Inflammation index, the Systemic Inflammation Response Index (SIRI), the Neutrophil-Lymphocyte ratio (NLR), the Neutrophil-Monocyte ratio, the Neutrophil-Platelet ratio and the Platelet-Lymphocyte ratio. Then, patients were prepared to undergo laparoscopy for diagnosis and staging.
Laparoscopy detected EM lesions in 63 patients; 27 of stage I-II and 36 of stage III-IV. Positive laparoscopy showed significant relation with US grading, high serum CA125 levels, platelet and inflammatory cell counts and indices. Statistical analyses defined high SIRI and NLR as the significant predictors for positive laparoscopy and high serum CA125 and NLR as the most significant predictors for severe EM (stage III-IV) on laparoscopy
The intimate relation between EM and inflammation was reflected systematically as high levels of blood cellular components, but indices related to neutrophil especially NLR and SIRI showed highly significant relation to the presence and severity of EM and might be used as routine, cheap and non-invasive screening test before exploratory laparoscopy to guide the decision-making.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-16-2007;20(2):83-89
DOI 10.1590/S0100-72031998000200005
Results on investigation and immune treatment for recurrent abortion are presented. Up to 60% of patients who are free of any clinical identifiable cause for abortion are believed to have alloimmune abnormalities. One of the suggested therapies for this condition is paternal lymphocyte immunization. We present the result of 116 pregnancies followed at the Departamento de Tocoginecologia UNICAMP. Patients were thoroughly evaluated for causes of recurrent abortion mentioned in the literature (genetics, hormones, uterine abnormalities and infections), for autoimmune (antiphospholipid syndrome, abnormal autoantibodies) and for alloimmune causes (crossmatch by microlymphocytotoxicity and mixed lymphocyte culture). Patients who presented negative crossmatch and lower than 50% inhibition in mixed lymphocyte culture were treated with two concentrated intradermal paternal lymphocyte immunizations. Women were stimulated to attempt pregnancy with a positive crossmatch and higher than 50% inhibition in mixed lymphocyte culture. Women whose immune status did not change with this treatment were immunized again with paternal lymphocytes associated or not to a third party donor. We report that 81% of the women treated with this protocol had good pregnancy outcome.