Andrea Prestes Nacul

Gene Expression of Leptin and Long Leptin Receptor Isoform in Endometriosis: A Case-Control Study

In this study, leptin/BMI ratio in serum and peritoneal fluid and gene expression of leptin and long form leptin receptor (OB-RL) were assessed in eutopic and ectopic endometria of women with endometriosis and controls. Increased serum leptin/BMI ratio was found in endometriosis patients. Leptin and OB-RL gene expression was significantly higher in ectopic versus eutopic endometrium of patients and controls. A positive, significant correlation was observed between leptin and OB-RL transcripts in ectopic endometria and also in eutopic endometria in endometriosis and control groups. A negative and significant correlation was found between OB-RL mRNA expression and peritoneal fluid leptin/BMI ratio only in endometriosis. These data suggest that, through a modulatory interaction with its active receptor, leptin might play a role in the development of endometrial implants.

Pregnancy in hyperprolactinemic women

We followed 10 pregnancies in a group of 90 hyperprolactinemic patients. Hyperprolactinemia was defined as prolactin.20ng/mL, measured on at least two occasions, from a pool of three samples. Prolactin dosage was processed by fluoroimmunoassay (DelfiaA, Wallac, Finland). Intra-assay and inter-assay sensitivity were 4.2% and 9.1%, respectively. All pregnancies occurred after bromocriptine treatment. In two cases, clomiphene citrate was also prescribed to induce ovulation. Patients with microadenoma and functional hyperprolactinemia received 5–10mg of bromocriptine/day and were advised to interrupt bromocriptine upon confirmation of pregnancy. Patients were monitored monthly throughout their pregnancy. Campimetry was performed every two or three months. Preand post-pregnancy prolactin levels, menstrual patterns, and tomographic studies were compared.

Aspectos neuroendócrinos na síndrome dos ovários policísticos

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is a heterogeneous clinical condition, characterized by hirsutism, acne and/or androgenetic alopecia, irregular menstrual cycles and infertility. Moreover, a considerable percentage of PCOS women present insulin resistance, in particular those with obesity. The pathogenesis of the syndrome is still unclear, but neuroendocrine mechanisms have been studied in the last years. Although an inappropriate GnRH/LH secretion is well established, some obese and hyperinsulinemic women with PCOS present an attenuation of these neuroendocrine abnormalities. Recently, we described a negative correlation between leptin and LH levels in PCOS patients, suggesting that the attenuation in basal or stimulated response of LH in obese PCOS patients might be related to a leptin-resistant state. On the other hand, there is some evidence that the somatotrophic axis plays a role in the pathogenesis of PCOS. Recent data from our group showed a higher clonidine-induced GH secretion in normal weight and normoinsulinemic PCOS patients than in patients with idiopathic hirsutism. Thus, GH could act as a co-gonadotropic factor stimulating androgen production by the ovary or, alternatively, these results may just represent an epiphenomenon related to the high androgen levels and subsequent conversion to estrogens. Further studies are needed to elucidate the mechanisms related to data described in the present work and their relevance on the etiopathogenesis, diagnosis and treatment of PCOS.

Comparação dos resultados do tratamento cirúrgico da incontinência urinária de esforço por três diferentes técnicas cirúrgicas

Purpose: to analyze the prevalence of genuine urinary incontinence (GUI) recurrence, after at least two years of follow-up, in different surgical techniques used for its correction. Patients and Methods: fifty-five patients with diagnosis of GUI, submitted to surgery for its repair at the Servico de Ginecologia e Obstetricia do Hospital de Clinicas de Porto Alegre from 1992 to 1996 and whose post-surgical follow-up was superior to 2 years were divided into three groups according to the surgical approach: Kelly-Kennedy (n = 24), Burch (n = 23) and Marshall-Marchetti-Krantz (n = 8). Results: there were no differences regarding recurrence rate, age at surgery and at recurrence time, estrogen therapy, number of pregnancies and vaginal delivery (p>0.05). Although posterior perineoplasty was more prevalent in the Kelly-Kennedy group, it did not influence the recurrence rate. The group submitted to the Burch approach had more years of menopause at the time of surgery. Conclusion: the recurrence rates of urinary incontinence comparing the three different techniques (Kelly-Kennedy, Burch and Marshall-Marchetti-Krantz) were, respectively, 29.2, 39.1 and 50%, which did not differ statistically. Considering the potential confusional bias for urinary stress incontinence, they did not differ among the groups. Nevertheless, we noticed that all women who had previous surgery presented recurrence of incontinence.