Clinical and pathomorphological characteristics of patients with purulent inflammation of the uterine appendages


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Abstract

Objective: To evaluate the clinical and morphological characteristics, the expression of cytokines in serum and peritoneal fluid in patients with tubo-ovarian abscesses (TOA). Materials and methods: A total of476 women were enrolled in the study, namely 456patients with TOA (the main group) and 20 healthy women who underwent laparoscopic sterilization with removal of the fallopian tubes (the control group). The study included clinical and anamnestic data, general clinical and biochemical parameters, cytokines (IL-1, IL-4, IL-6, TNF-a, fibronectin) in serum and peritoneal fluid, histological and morphometric parameters. Results: The patients of the main group showed an increase in the level of anti-inflammatory cytokines IL-1P, IL-6, TNF-a, fibronectin, both in serum and peritoneal fluid. The average value of IL-1P in the blood of healthy women was 14.22 (1.33) pg/ml, and it was 381.6 (22.2) in the patients of the main group; TNF-a was 2.79 (0.54) and 56.34 (7.42) pg/ml, respectively; IL-6 was 3.19 (0.27) and 7.69 (0.52) pg/ml, respectively; fibronectin was 324.05 (12.82) and 2729.04 (253.74) pg/ml, respectively. A similar increase in the level of all pro-inflammatory cytokines was noted in the peritoneal fluid in women of the main group. The values of IL-4 in patients with TOA were reduced in all biological media compared to healthy women. Morphometric analysis revealed an increase in the volume density of connective tissue in TOA wall to 51.2 (3.7) %, and a decrease in the muscle tissue volume to 6.09 (0.05) %, which was 8.5 times less than the same indicator in the healthy controls. All the differences were statistically significant. Conclusion: The obtained results indicate that there is an increase in the production of pro-inflammatory cytokines in patients with TOA, along with a decrease in the production of anti-inflammatory ones, both in serum and exudate. Histological and morphometric changes conf irm the loss of function of the uterine appendages.

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About the authors

Elena P. Shatunova

Medical University REAVIZ; Samara State Medical University

Email: e.shatunova@mail.ru
Dr. Med. Sci., Professor, Head of the Department of obstetrics and gynecology with a course of endoscopic surgery and simulation training

Tatyana A. Fedorina

Samara State Medical University

Email: fedorina_ta@list.ru
Honored Worker of the Higher School of the Russian Federation, Dr. Med. Sci., Professor, Head of the Department of General and Clinical Pathology

Olga I. Lineva

Samara State Medical University

Email: olineva@yandex.ru
Honored Doctor of the Russian Federation, Honorary Professor of SamSMU, Dr. Med. Sci., Professor of the Department of Obstetrics and Gynecology No. 2

Lilia V. Kuznetsova

Medical University REAVIZ; N.I. Pirogov City Clinical Hospital No. 1

PhD, Head of the Department of Gynecology, N.I. Pirogov City Hospital No. 1, Associate Professor of the Department of Obstetrics and Gynecology with a course of endoscopic surgery and simulation training

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