Cristián Miranda

Release of norepinephrine from human ovary: coupling to steroidogenic response.

We investigated the possibility that norepinephrine from the human ovary is released after nerve stimulation and that this neurotransmitter is coupled to a steroidogenic response. Biologically significant levels of both norepinephrine and dopamine were found in human ovarian biopsies. [3H]norepinephrine incorporated in vitro was readily released by electrical stimulation in a Ca2+-dependent process. Ovarian membrane preparations exhibited specific binding sites for the β-adrenergic antagonist [3H]dihydroalprenolol. displacement of [3H]dihydroalprenolol with zinterol (a specific β2-agonist, indicated that 72% of these sites were type β2-receptors. β-receptors were also present on granulosa cells. Stimulation of granulosa cells with luteinizing hormone or the β-agonist isoproterenol increased the release of progesterone after 4 d in culture. These results suggest that the sympathetic nerves present in human ovary are coupled to β-adrenergic receptors present in endocrine cells and, as in nonprimate mammals, appear to participate in the regulation of ovarian function.

ESTUDIO DESCRIPTIVO DE LOS ASPECTOS EMOCIONALES ASOCIADOS A LA INFERTILIDAD Y SU TRATAMIENTO

El objetivo de este estudio fue describir los principales aspectos emocionales asociados a la infertilidad y su tratamiento. Con este fin, se evaluaron 106 pacientes infertiles, 72 mujeres y 34 varones, en tratamiento en Unidades de Medicina Reproductiva de la ciudad de Santiago. Se encontraron diferencias en la reaccion psicologica de mujeres y hombres. Mientras en las primeras predomino la inestabilidad del animo (75%), pena (68,1%) y rabia (50%), entre los varones fueron mas frecuentes la ansiedad (46,7%), la pena (36,7%) y la inestabilidad del animo (33,3%). En lo laboral, las mujeres expresaron dificultades para asistir a los controles y la percepcion de menoscabo en el rendimiento. Los varones a menudo manifestaron tener que trabajar mas para asumir los gastos. En ambos sexos se observo una asociacion entre acumulacion de vivencias negativas y mayores grados de compromiso en los ambitos social y laboral. Tambien ambos sexos coincidieron en opinar que la infertilidad afecta mas la vida sexual (33,7%) que la relacion de pareja (15,4%)

ENDOMETRIOSIS DE LA PARED ABDOMINAL

SUMMARY Background: The presence of abdominal wall endometriosis (AWE) used to be confused with other surgical pathologies that may appear in these zones. Objective: To evaluate the AWE clinical characteristics. Method: Retrospective study of all the patients hospitalized with the histopathologycal diagnosis of AWE, between January 1997 and December 2005. Results: There was found AWE only in 14 patients. Their mean age was 33.2 years old. The symptoms were: cyclic pain (71.4%), abdominal wall mass (100%), dyspareunia (21.4%) and dysmenorrhea (42.8%). All patients had at least one gynecologic (2 patients with laparoscopic procedures) or obstetric surgery (85.7% had previous cesarean section). Only one patient had previously been diagnosed with pelvic endometriosis. Their symptoms started after an average of 3.5 years after surgery. The AWE had a mean size of 3.2 cm. The preoperative diagnosis was correct in 64.3%. The incorrect preoperative diagnoses were 3 granuloma, 1 inguinal hernia and 1 lipoma. All patients required surgery. 64.3% of the patients it was necessary a polytetrafluoethylene mesh. Four patients (28.5%) had AWE recurrences. 60% of the wrong initial diagnosis recurred versus 11.1% of the

Laparoscopic tubal reanastomosis

Traditionally, tubal reanastomosis has been performed microscopically via laparotomy. The laparoscopic approach has revealed high pregnancy rates comparable with those obtained after microsurgery by laparotomy and yields important advantages such a less postoperative discomfort and fewer complications, no incisional scar, a shorter recovery time, and earlier resumption of normal activities. The one-stitch technique gives a good approximation of the tissues with a shorter operative time and successful results. In this report we present a case of tubal reanastomosis by laparoscopy using the one-stitch technique, which resulted in an intrauterine pregnancy.

Abordaje vaginoscópica para la realización de histeroscopía oficinal: experiencia, resultados y revisión de la literatura

SUMMARY Objective: To present our experience and a review of the literature of the vaginohysteroscopic technique. To describe the main indications, the tolerance, the procedures performed and their complications. Method: This is a descriptive study of all outpatient procedures performed with the vaginohysteroscopic technique in the Reproductive Medicine and Infertility Unit of the Department of Obstetrics and Gynecology at University Hospital of Chile between 1st January of 2008 and 31st January of 2014. Results: A total of 632 vaginohysteroscopys were performed: 63.7% diagnostic and 36.2% surgical. The average procedure time was 13 ± 8 minutes. Pain showed a median of VAS of 4. The main indication was suspected endometrial polyps (33%) and endometrial thickening (12%). The most frequent finding was normal endometrial cavity (27%) and endometrial polyps (27%). The most common procedures were polypectomy (27%) and endometrial biopsies (20%). We registered 17 complications (2.6%): 14 vasovagal reactions (2.2%) and 3 lipothymias (0.4%). Conclusions: vaginohisteroscopy approach has proven to be a safe and very resolutive technique, well tolerated by patients and considerably cost-effective.

Nerve Growth Factor Induces Vascular Endothelial Growth Factor Expression in Granulosa Cells via a trkA Receptor/Mitogen-Activated Protein Kinase-Extracellularly Regulated Kinase 2-Dependent Pathway

Background: The clinical manifestations of resistance to thyroid hormone (RTH) are highly variable, and the impact of RTH on the cardiovascular system has been poorly investigated. Aim: The objective of the study was to evaluate the cardiovascular characteristics of 16 untreated and asymptomatic patients with RTH compared with 16 euthyroid healthy controls to define the cardiovascular involvement in RTH syndrome. Patients and Methods: Sixteen untreated and asymptomatic RTH patients (eight males; aged 33 12 yr, range 21–45 yr) and 16 controls (nine males; aged 33 5 yr, range 24–42 yr) were enrolled. Clinical data, thyroid status, and echocardiographic results were recorded. Results: Heart rate was comparable with that of controls, whereas arterial pressure was higher than controls. Mean interventricular septum diastolic thickness and mean left ventricular (LV) posterior wall diastolic thickness were significantly lower in RTH patients than controls with a consequent significant decrease of the mean LV mass and LV mass indexed by body surface area. Patients also had abnormalities of myocardial relaxation as indicated by a significant increase of peak A and consequent reduction of the early to late ratio. Finally, systemic vascular resistance was significantly higher in RTH patients than controls. Conclusions: Our results suggest the presence of cardiovascular alterations in asymptomatic and untreated RTH patients similar to those reported in hypothyroid patients. Our strict selection likely created a bias in the inclusion of a particular type of RTH patients, who could represent a minority of patients with RTH. However, no correlation was found between the type of mutation and cardiovascular characteristics of RTH patients. Nerve Growth Factor Induces Vascular Endothelial Growth Factor Expression in Granulosa Cells via a trkA Receptor/Mitogen-Activated Protein Kinase-Extracellularly Regulated Kinase 2-Dependent Pathway Marcela Julio-Pieper, Patricia Lozada, Veronica Tapia, Margarita Vega, Cristian Miranda, David Vantman, Sergio R. Ojeda, and Carmen Romero (J Clin Endocrinol Metab, published May 19, 2009, 10.1210/jc.2009-0542) ABSTRACT Context: Acquisition of ovulatory competence by antral follicles requires development of an adequate vascular supply. Although it is well established that ovarian angiogenesis is cyclically regulated by vascular endothelial growth factor (VEGF), the factors controlling VEGF production by ovarian follicles remain largely unknown. Nerve growth factor (NGF) may be one of these factors, because NGF promotes angiogenesis and synthesis of angiogenic factors in other tissues and is produced by human granulosa cells (hGCs). Objective: The aim of the study was to determine whether NGF influences the production of VEGF by hGCs and to identify a potential signaling pathway underlying this effect. Design: We conducted a prospective experimental study. Patients: hGCs were obtained from 41 women participating in the in vitro fertilization program of our institution. Methods: Changes in VEGF mRNA after exposure to NGF were evaluated in cultured hGCs by PCR and real-time PCR. The effect of NGF on VEGF secretion was determined by ELISA. The involvement of trkA, the high affinity NGF receptor, was examined by inhibiting the receptor’s tyrosine kinase activity with K252a. The contribution of an ERK1/ERK2-mediated signaling pathway was identified by detecting NGF-dependent phosphorylation of these proteins and by blocking their activity with the inhibitor U0126. T R A N S L A T I O N A L H I G H L I G H T S F R O M J C E MContext: Acquisition of ovulatory competence by antral follicles requires development of an adequate vascular supply. Although it is well established that ovarian angiogenesis is cyclically regulated by vascular endothelial growth factor (VEGF), the factors controlling VEGF production by ovarian follicles remain largely unknown. Nerve growth factor (NGF) may be one of these factors, because NGF promotes angiogenesis and synthesis of angiogenic factors in other tissues and is produced by human granulosa cells (hGCs). Objective: The aim of the study was to determine whether NGF influences the production of VEGF by hGCs and to identify a potential signaling pathway underlying this effect. Design: We conducted a prospective experimental study. Patients: hGCs were obtained from 41 women participating in the in vitro fertilization program of our institution. Methods: Changes in VEGF mRNA after exposure to NGF were evaluated in cultured hGCs by PCR and real-time PCR. The effect of NGF on VEGF secretion was determined by ELISA. The involvement of trkA, the high affinity NGF receptor, was examined by inhibiting the receptor’s tyrosine kinase activity with K252a. The contribution of an ERK1/ERK2-mediated signaling pathway was identified by detecting NGF-dependent phosphorylation of these proteins and by blocking their activity with the inhibitor U0126. T R A N S L A T I O N A L H I G H L I G H T S F R O M J C E M

PERCEPCION DEL PACIENTE INFERTIL ACERCA DEL EQUIPO MEDICO TRATANTE

El objetivo de este estudio fue describir la percepcion del paciente infertil acerca del equipo medico tratante y conocer sus expectativas de recibir apoyo emocional. Se evaluaron 106 pacientes infertiles, 72 mujeres y 34 varones, en tratamiento en Unidades de Medicina Reproductiva de la ciudad de Santiago. Los pacientes evaluaron como buena la informacion entregada por el medico. No obstante, la mayoria (89%) declaro desear recibir mas informacion sobre infertilidad. La acogida por parte del equipo medico tratante fue evaluada como regular (promedio 3,9 en escala 1 a 5), influyendo negativamente en la percepcion de los pacientes la dificultad en el contacto telefonico y la falta de continuidad del equipo tratante. En otros aspectos la percepcion de acogida fue positiva, tanto en el contexto del hospital universitario como en el de las clinicas privadas. Para las mujeres, haber sido citadas con su pareja se correlaciono positivamente con la percepcion de ser escuchadas por su medico