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Fibrinolysis in the Peritoneal Fluid During Adhesions, Endometriosis and Ongoing Pelvic Inflammatory Disease

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Abstract

The concentrations of the specific activators (u-PA and t-PA) and the specific inhibitors (PAI-1 and PAI-2) of the fibrinolytic system were analyzed in the peritoneal fluid in women suffering from intra-abdominal adhesions, endometriosis or pelvic inflammatory diseases (PID). Peritoneal fluids were collected from ten women in whom a laparotomy was performed and an additional 108 in whom a laparoscopy was carried out. In comparison with the normal control patients all activators and inhibitors were significantly increased in cases of PID and when a second-look laparoscopy was performed one week after laparotomy with adhesiolysis. At laparoscopies, when adhesions were verified, u-PA in the peritoneal fluid was significantly increased and in cases of endometriosis PAI-2 was significantly reduced. The start of a laparotomy in order to remove adhesions, initiates a process, resulting in a significant increase of PAI-2 antigen in the pelvic fluid. The results imply that the fibrinolytic system is comprehensively activated in the peritoneal cavity during ongoing inflammatory reaction, and after adhesiolysis. The increase in plasminogen activators in the peritoneal fluid in established cases of pelvic adhesions or endometriosis may indicate that the fibrinolytic system is continuously active to inhibit the further formation of adhesions.

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REFERENCES

  1. Ellis, H. 1971. The cause and prevention of postoperative adhesions. Surg. Gynaecol. 133:497–511.

    Google Scholar 

  2. Lalos, O. 1988. Risk factors for tubal infertility among infertile and fertile women. Eur. J. Obstet, Gynecol. Reprod. Biol. 29:129–136.

    Google Scholar 

  3. Laatikainen, T. J., A. K. Tenhunen, P. K. Venesmaa, and D. L. Apter. 1988. Factors influencing the success of microsurgery for distal tubal occlusion. Arch. Gynecol. Obstet. 243:101–106.

    PubMed  Google Scholar 

  4. Boer-Meisel, M. E., E. R. te Velde, J. D. F. Habbema, and J. W. P. F. Kardaun. 1986. Predicting the pregnancy outcome in patients treated for hydrosalpinx: a prospective study. Fertil. Steril. 45:23–29.

    PubMed  Google Scholar 

  5. Syrop, C. H., and J. Halme. 1987. Peritoneal fluid environment and infertility. Fertil. Steril. 48:1.

    PubMed  Google Scholar 

  6. Rubin, J., G. A. Herrera, and D. Collins. 1991. An autopsy study of the peritoneal cavity from patients on continuous ambulatory peritoneal dialysis. Am. J. Kidney Dis. 18:97–102.

    PubMed  Google Scholar 

  7. The American Fertility Society. 1985. Revised American Fertility Classification of endometriosis: Fertil. Steril. 43:351–352.

    Google Scholar 

  8. Buckman, R. F., M. Woods, L. Sargent, and A. S. Gervin. 1976. A unifying Pathogenic Mechanism in the Etiology of Intraperitoneal Adhesions. J. Surg. Research. 20:1–5.

    Article  Google Scholar 

  9. O'Leary, D. P., and J. B. Coakley. 1992. The influence of suturing and sepsis on the development of postoperative adhesions. Ann. R. Coll. Surg. Engl. 74:134–137.

    PubMed  Google Scholar 

  10. Holmdahl, L. 1994. Fibrinolysis and Adhesions, Dissertation from the Department of Surgery, University of Göteborg, Sweden.

    Google Scholar 

  11. Thejls, H., G. Heimer, J. Gnarpe, G. Larsson, Ö, Lundkvist, and A. Victor, 1991. Diagnosis and prevalence of persistent Chlamydia infection in infertile women: Tissue culture, direct antigen detection and serology. Fertile. Steril. 55:304–310.

    Google Scholar 

  12. Edelstam, G. Infertility and Pelvic Adhesions. 1994. Doctoral dissertation from the Faculty of Medicine, Uppsala University, Uppsala, Sweden.

    Google Scholar 

  13. Patton, D. L., M. Askienazy-Elbhar, J. Henry-Suchet, L. A. Campbell, A. Cappuccio, W. Tannous, S. Wang, and C. Kuo. 1994. Detection of Chlamydia trachomatis in fallopian tube tissue in women with postinfectious tubal infertility. Am. J. Obstet. Gynecol. 171:95–101.

    PubMed  Google Scholar 

  14. Bouckart, P. X. J. M., J. A. Land, E. J. P. Brommer, J. J. Emeis, and J. L. H. Evers. 1990. The impact of peritoneal trauma on intra-abdominal fibrinolytic activity, adhesions formation and early embryonic development in a rabbit longitudinal model. Hum. Reprod. 5:237–241.

    PubMed  Google Scholar 

  15. Batzofin, J. H., S. D. Holmes, W. E. Gibbons, and V. C. Buttram. 1985. Peritoneal fluid plasminogen activator activity in endometriosis and pelvic adhesive disease. Fertil. Steril. 44:277–279.

    PubMed  Google Scholar 

  16. DÖrr, P. J., E. J. P. Brommer, G. Dooijewaard, and H. M. Wemer. 1993. Parameters of Fibrinolysis in peritoneal fluid and plasma in different stages of the menstrual cycle. Thrombosis and Haemostasis. 70:873–875.

    PubMed  Google Scholar 

  17. Edelstam, G. A. B., Ö. E. Lundkvist, P. Venge, and T. C. Laurent: 1994. Hyaluronan and myeloperoxidase in the peritoneal fluid during genital inflammation. Inflammation. 18:13–21.

    PubMed  Google Scholar 

  18. Grinnell, F., M. Milam, and P. A. Srere. 1972. Studies on cell adhesion. Arch. Biochem. Biophys. 153:193–198.

    PubMed  Google Scholar 

  19. Lecander, I., and B. Åstedt. 1987. Specific plasminogen activator inhibitor of placental type PAI-2 occurring in amniotic fluid and cord blood. J. Lab. Clin. Med. 110:602–605.

    PubMed  Google Scholar 

  20. Colton, T. 1974. Nonparametric methods. In: Colton T. Statistics in medicine. Little, Brown and Company. Boston, Massachusetts. pp 219–227.

    Google Scholar 

  21. DiZerega, G. S. 1994. Contemporary adhesions prevention. Fertil. Steril. 61:219–235.

    PubMed  Google Scholar 

  22. Pijlman, B. M., P. J. DÖrr, E. J. P. Brommer, and H. M. Vemer. 1994. Prevention of adhesions. Eur. J. Obstet. Gynecol. Reprod. Biol. 53:155–163.

    PubMed  Google Scholar 

  23. Gauwerky, J. H. F., J. Mann, and G. Bastert. 1990. The effect of fibrin glue and peritoneal graft in the prevention of intraperitoneal tissue. Arch. Gynecol. Obstst. 247:161–166.

    Google Scholar 

  24. Monk, B. J., M. L. Berman, and F. J. Montz. 1994. Adhesions after extensive gynecologic surgery, clinical significance, etiology and prevention. Am. J. Obstet. and Gynecol. 170:1396–1403.

    Google Scholar 

  25. Menzies, D., and H. Ellis. 1989. Intra-abdominal adhesions and their prevention by topical tissue plasminogen activator. J. Royal. Soc. Medicine. 82:534–535.

    Google Scholar 

  26. DÖrr, P. J., H. M. Vemer, E. J. Brommer, W. N. Willemsen, R. W. Veldhizen, and R. Rolland. 1990. Prevention of postoperative adhesions by tissue-type plasminogen activator (t-PA) in the rabbit. Eur. J. Obstet. Gyn. Reprod. Biol. 37:287–291.

    Google Scholar 

  27. Holmdahl, L. The role of fibrinolysis in adhesion formation. 1997. Eur. J. Surg. 577:24–31.

    Google Scholar 

  28. Evans, D. M., K. McAree, D. P. Guyton, N. Hawkins and K. Stakleff. 1993. Dose dependency and wound healing aspects of the use of tissue plasminogen activator in the prevention of intraabdominal adhesions. Am. J. Surg. 165:229–232.

    PubMed  Google Scholar 

  29. Edelstam, G. A. B. and A. Karlsson-Parra. 1996. The human leucocyte antigen (HLA) DR expression and the distribution of T-lymphocytes in the fimbriae of the normal fallopian tube and during pelvic adhesion disease. Am. J. Reprod. Immunol. 35:471–476.

    PubMed  Google Scholar 

  30. Åstedt, B., and F. NordenskjÖld. 1984. Plasminogen Activators in Endometriosis. Acta Obstet. Gyn. Scand. 123:23–24.

    Google Scholar 

  31. Scott-Coombes, D., S. Whawell, M. N. Vipond, and J. Thompson. 1995. Human intraperitoneal fibrinolytic response to elective surgery. Br. J. Surg. 82:414–417.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden

    Greta Edelstam

  2. Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden

    Ingegerd Lecander & Birger Åstedt

  3. it>Department of Obstetrics and Gynecology, Karolinska Institute, Danderyd Hospital, Danderyd's, Sweden

    Bertil Larsson

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  1. Greta Edelstam
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  2. Ingegerd Lecander
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  3. Bertil Larsson
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  4. Birger Åstedt
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Edelstam, G., Lecander, I., Larsson, B. et al. Fibrinolysis in the Peritoneal Fluid During Adhesions, Endometriosis and Ongoing Pelvic Inflammatory Disease. Inflammation 22, 341–351 (1998). https://doi.org/10.1023/A:1022322814288

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