Geraldo Rodrigues de Lima

Benefits of soy isoflavone therapeutic regimen on menopausal symptoms

OBJECTIVE To examine the change in menopausal symptoms and cardiovascular risk factors in response to 4 months of daily 100‐mg soy isoflavone in postmenopausal women. METHODS In this double‐blind, placebo‐controlled study, 80 women were randomly assigned to isoflavone (n = 40) and placebo (n = 40) treatment. The menopausal Kupperman index was used to assess change in menopausal symptoms at baseline and after 4 months of treatment. Cardiovascular risk factors were assessed by evaluating plasma lipid levels, body mass index, blood pressure, and glucose levels in the participants. To examine the effects of this regime on endogenous hormone levels, follicle‐stimulating hormone (FSH), luteinizing hormone (LH), and 17β‐estradiol were measured. Transvaginal sonography was performed to quantify endometrial thickness. RESULTS The data showed a decrease in menopausal symptoms (P < .01, paired t test, two‐tailed, between baseline and isoflavone groups, and P < .01, unpaired t test, between placebo and isoflavone groups). Total cholesterol and low‐density lipoprotein decreased significantly in the isoflavone group compared with the baseline or placebo group (P < .001, paired t test, two‐tailed, between baseline and isoflavone groups, and P < .01, unpaired t test, between placebo and isoflavone groups). The isoflavone treatment appeared to have no effect on blood pressure, plasma glucose, and high‐density lipoprotein and triglyceride levels. CONCLUSION This study suggests that isoflavone 100‐mg regime treatment may be a safe and effective alternative therapy for menopausal symptoms and may offer a benefit to the cardiovascular system.

Validação do questionário de qualidade de vida (King's Health Questionnaire) em mulheres brasileiras com incontinência urinária

Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Ambulatorio de Uroginecologia e Mioma

Assessment of the proliferative, apoptotic and cellular renovation indices of the human mammary epithelium during the follicular and luteal phases of the menstrual cycle

IntroductionDuring the menstrual cycle, the mammary gland goes through sequential waves of proliferation and apoptosis. In mammary epithelial cells, hormonal and non-hormonal factors regulate apoptosis. To determine the cyclical effects of gonadal steroids on breast homeostasis, we evaluated the apoptotic index (AI) determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining in human mammary epithelial cells during the spontaneous menstrual cycle and correlated it with cellular proliferation as determined by the expression of Ki-67 during the same period.MethodsNormal breast tissue samples were obtained from 42 randomly selected patients in the proliferative (n = 21) and luteal (n = 21) phases. Menstrual cycle phase characterization was based on the date of the last and subsequent menses, and on progesterone serum levels obtained at the time of biopsy.ResultsThe proliferation index (PI), defined as the number of Ki-67-positive nuclei per 1,000 epithelial cells, was significantly larger in the luteal phase (30.46) than in the follicular phase (13.45; P = 0.0033). The AI was defined as the number of TUNEL-positive cells per 1,000 epithelial cells. The average AI values in both phases of the menstrual cycle were not statistically significant (P = 0.21). However, the cell renewal index (CRI = PI/AI) was significantly higher in the luteal phase (P = 0.033). A significant cyclical variation of PI, AI and CRI was observed. PI and AI peaks occurred on about the 24th day of the menstrual cycle, whereas the CRI reached higher values on the 28th day.ConclusionsWe conclude that proliferative activity is dependent mainly on hormonal fluctuations, whereas apoptotic activity is probably regulated by hormonal and non-hormonal factors.

Frequency of endometriotic lesions in peritoneum samples from asymptomatic fertile women and correlation with CA125 values

CONTEXT AND OBJECTIVE Serological testing for CA125 has been widely used to detect endometriosis and to monitor its progression. However, controversy still exists regarding the usefulness of the plasma CA125 assay for diagnosing endometriosis. Furthermore, some authors have described superficial endometriosis as a cyclical and normal phenomenon in womens lives, and have indicated that development and progression of this disease would only occur in some women as a result of immunological changes. This study aimed to determine the frequency of endometriosis and the correlation between serum CA125 levels and the presence of endometriotic lesions in the peritoneum of asymptomatic fertile patients. DESIGN AND SETTING Cross-sectional study at the Family Planning outpatient clinic of Faculdade de Medicina do ABC. METHODS Eighty asymptomatic fertile patients who underwent tubal sterilization surgery were studied. Blood and peritoneum samples were collected. CA125 levels were measured from blood samples, and peritoneum biopsies were studied using histopathological tests. RESULTS Histopathological evaluation of the peritoneum revealed that 16.25% of the patients had minimal or mild endometriosis. There was no statistically significant difference in CA125 levels between patients with and without endometriosis. CONCLUSION The presence of endometriotic lesions in the peritoneum of fertile patients supports the hypothesis that incidental findings of minimal or mild endometriosis may not be of clinical significance, and that the progression of the disease probably occurs as a result of immunological and genetic abnormalities. Serum CA125 levels did not show any diagnostic significance with regard to detecting the disease.

Power Doppler of the Urethra in Continent or Incontinent, Pre- and Postmenopausal Women

Abstract: Urethral pressure should exceed bladder pressure, both at rest and on stress, for urinary continence to occur. A decrease in urethral pressure is a major factor explaining the pathogenesis of urinary incontinence. A number of elements, such as smooth and striated periurethral muscles, and connective, vascular and elastic tissues, contribute to urethral pressure. The periurethral vessels are influenced by hormonal changes during the menstrual cycle, during pregnancy and postmenopause. We studied the periurethral vessels in 97 women, 57 of whom were incontinent and 40 continent, using power color Doppler velocimetry. The number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes, as well as systolic–diastolic ratio, were assessed. Statistically significant differences were found between incontinent women in the premenopausal period and those in the postmenopausal period, regarding the number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes.

OC-125 immunostaining in endometriotic lesion samples.

PurposeTo determine the presence of OC-125 staining in endometriotic lesions and to verify whether there is an association with endometriosis stage.MethodsThirteen patients from the Family Planning programs (group I) and 53 patients from the Chronic Pelvic Pain outpatient clinic (group II) were studied. Endometriotic lesions were excised from areas of endometriosis incidence and studied by histopathological assay and by immunohistochemistry for OC-125 staining.ResultsThe histopathological study disclosed that all patients from group I had minimal/mild endometriosis. In group II, 39.6% had minimal/mild endometriosis, and 60.4% had moderate/severe endometriosis. OC-125 staining was negative in all samples from group I. In group II, OC-125 staining was positive in 52.4% patients with minimal/mild endometriosis and in 81.2% with moderate/severe endometriosis.ConclusionThe data suggest that the OC-125 antibody is probably related to endometriosis activity and, consequently, to the progression and severity of the illness.

Glycosaminoglycan profile in bladder and urethra of castrated rats treated with estrogen, progestogen, and raloxifene

OBJECTIVE This study was undertaken to evaluate the action of conjugated equine estrogens alone, medroxyprogesterone, the combination of these estrogens with progestogens, and of raloxifene on the glycosaminoglycan profile in the bladder and urethra of adult oophorectomized rats in comparison with noncastrated rats. STUDY DESIGN Sixty adult rats, of which 50 were submitted to bilateral oophorectomy, were studied. After 4 days, the latter were assigned to five groups of 10 animals each. For 30 consecutive days the following treatments were given: group 1, conjugated equine estrogens; group 2, conjugated equine estrogens combined with medroxyprogesterone acetate; group 3, medroxyprogesterone; group 4, raloxifene; and group 5, placebo. Thereafter the bladders and urethras of the animals were removed, processed to yield a dry powder of which the sulfated glycosaminoglycan content was determined by densitometry after agarose gel electrophoresis and that of hyaluronic acid by a fluorimetric assay. RESULTS Glycosaminoglycans found in the bladder and urethra were dermatan sulfate, heparan sulfate, and hyaluronic acid. In the bladder, hypoestrogenism or replacement with estrogens led to a lower sulfated glycosaminoglycan content. Replacement with estrogens and/or medroxyprogesterone reverted this effect. Hypoestrogenism decreased the dermatan sulfate/heparan sulfate ratio and reduced hyaluronic acid content. Estrogen therapy reverted this alteration and medroxyprogesterone addition annulled the estrogenic effect. In the urethra, castration did not alter hyaluronic acid content and sulfated glycosaminoglycan content, but raloxifene decreased the latter. CONCLUSION Castrated rats had a decrease in sulfated glycosaminoglycans and hyaluronic acid content in the bladder. Hormonal replacement altered the quantity and quality of glycosaminoglycans. In the urethra, raloxifene reduced sulfated glycosaminoglycans.

Valor da Queixa Clínica e Exame Físico no Diagnóstico da Incontinência Urinária

Objetivo: analisar a prevalencia das queixas clinicas uroginecologicas correlacionando-as com o diagnostico definitivo apos o exame urodinâmico e comparar o sinal clinico de perda urinaria com o estudo urodinâmico. Metodos: foram analisadas, retrospectivamente, 114 pacientes atendidas no periodo de junho de 2000 a janeiro de 2001. Todas as pacientes foram avaliadas por meio de anamnese padronizada, exame fisico e estudo urodinâmico, sendo classificadas de acordo com o queixa clinica, presenca do sinal de perda urinaria durante o exame ginecologico e diagnostico urodinâmico. Utilizou-se a analise estatistica dos dados amostrais, por meio da determinacao interna de um teste diagnostico, para calcular a sensibilidade, especificidade e os valores preditivos positivo e negativo do sinal clinico. Resultados: a media de idade foi de 51 anos (19-80), sendo que 61 encontravam-se no menacme (53,5%) e 53 (46,5%) na pos-menopausa. Destas, 10 (18,8%) faziam uso da terapia de reposicao hormonal. Do total de pacientes, 25 (21,9%) haviam se submetido a cirurgias previas para incontinencia. A queixa de perda urinaria isolada foi referida por 41 pacientes (36,0%), a urgencia/urge-incontinencia isolada por 13 (11,4%) e os sintomas mistos por 60 (52,6%). Das pacientes com perda isolada, observou-se, a avaliacao urodinâmica, que 34 (83%) tinham incontinencia urinaria de esforco (IUE), nenhuma paciente apresentava instabilidade do detrusor (ID), 2 (4,9%) incontinencia urinaria mista (IUM) e em 5 (12,1%) o estudo foi normal. Daquelas com queixa de urgencia/urge-incontinencia isolada, observamos na avaliacao urodinâmica que nenhuma tinha IUE, 5 (38,5%) ID, 1 (7,7%) IUM e em 7 (53,8%) o estudo foi normal. Daquelas com sintomas mistos, identificamos na avaliacao urodinâmica 25 com IUE (41,6%), 10 com ID (16,7%), 10 IUM (16,7%) e em 15 o estudo foi normal (25,0%). O sinal clinico de perda ao exame fisico foi identificado em 50 (43,9%) pacientes. Destas, 35 (70%) tinham diagnostico urodinâmico de IUE, 6 (12%) IUE e outro diagnostico e 9 (18%) nao tinham IUE. O sinal clinico estava ausente em 64 (56,1%) mulheres. Destas, 23 (35,9%) tinham diagnostico urodinâmico de IUE, 7 (11%) IUE e outro diagnostico e 34 (53,1%) nao tinham IUE. Conclusoes: a historia clinica associada ao exame fisico tem importância no manejo da incontinencia urinaria; porem, nao devem ser utilizados como unico criterio para o diagnostico. Os testes objetivos estao disponiveis e devem ser utilizados em conjunto com os dados clinicos.

Doppler Velocimetry Parameters of Periurethral Vessels in Postmenopausal Incontinent Women Receiving Estrogen Replacement

Abstract: Estrogen deficit causes significant alterations in the lower urinary tract of women, largely affecting urinary continence mechanisms. The urethral vascular bed accounts for about one-third of urethral pressure, and as it undergoes marked hormonal influence we became interested in investigating its behaviour both prior to and during estrogen replacement. We selected 25 postmenopausal patients with urinary stress incontinence and studied the periurethral vessels by means of Doppler velocimetry, analyzing the number of vessels, systolic peak, minimum diastole, resistance and pulsatility indexes and the A/B ratio, prior to estrogen replacement and after 1 and 3 months of hormone use. We concluded that estrogen replacement alone in postmenopausal women with urinary stress incontinence increased the number of periurethral vessels, systolic peak and minimum diastole; however, a trend of no statistical significance towards the reduction of resistance and pulsatility rates of periurethral vessels was found; nor was a significant difference in the A/B ratio shown.

Diagnóstico clínico e subsidiário da incontinência urinária

Female lower urinary tract symptoms are nonspecific and a clinical evaluation is required to establish the correct diagnosis. Such evaluation should consist of a structured micturition history or questionnaire, physical examination, micturition diary, pad test, and urodynamic evaluation. Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the etiology of the patients complaints. The goal of the present article is to review clinical and subsidiary diagnosis of urinary incontinence.