Kleber Pimentel

Aromatase and cyclooxygenase-2 expression in endometrial polyps during the menstrual cycle

Objectives. To study the changes in aromatase, Ki-67 and cyclooxygenase-2 (COX-2) expression during the menstrual cycle in both endometrial polyps and normal endometria. Patients and methods. Paraffin-embedded tissue samples from 118 premenopausal patients were submitted to immunohistochemistry for measurement of aromatase, COX-2 and Ki-67 expression. Fifty cases of endometrial polyps and 68 cases of disease-free endometrium were included. Results. The presence of aromatase expression was significantly higher in endometrial polyps than in disease-free endometria. On the other hand, changes in COX-2 and Ki-67 expression followed a similar pattern during the menstrual cycle in both groups, expression peaking during the proliferative phase and falling during the late luteal phase. Conclusion. A significantly higher proportion of endometrial polyps express aromatase compared with disease-free endometrium; however, no correlation was found between aromatase expression and changes in either Ki-67 or COX-2 expression during the menstrual cycle.

Effect of the menstrual cycle and oral contraceptives on aromatase and cyclooxygenase-2 expression in adenomyosis.

Objectives. To determine whether aromatase expression in the eutopic endometrium and adenomyotic foci is affected by previous use of oral contraceptives containing gestodene, and to determine whether changes in cyclooxygenase-2 (COX-2) expression occur in adenomyosis during the menstrual cycle. Patient and methods. This was a retrospective cohort study carried out in paraffin-embedded endometrial tissue obtained from patients with a histological diagnosis of adenomyosis obtained during the proliferative (n = 25) and luteal (n = 10) phases of the menstrual cycle and following the use of continuous oral contraception with gestodene/ethinyl estradiol (n = 7). COX-2 and aromatase expression were measured in both eutopic endometrium and adenomyotic foci using immunohistochemical methods. Results. Aromatase expression was detected in 80% of the endometrial slices by immunohistochemistry. In positive cases, aromatase was mainly detected in the stromal cells of the eutopic endometrium, whereas in the adenomyotic foci this expression was negative in the majority of the cases. Oral contraceptives containing gestodene, on the other hand, were effective in suppressing aromatase expression in both eutopic and ectopic endometrium. COX-2 expression was detected by immunohistochemistry in the glandular epithelium of both eutopic endometrium and adenomyotic foci and there were no significant changes in its intensity throughout the menstrual cycle. Conclusion. Aromatase expression in the eutopic endometrium and adenomyotic foci is suppressed by oral contraceptives containing gestodene. Increased aromatase activity may be responsible for the persistent COX-2 expression during the luteal phase.

The effect of oral contraceptives on aromatase expression in the eutopic endometrium of patients with endometriosis

Objective. To determine the effect of oral contraceptives containing gestodene on aromatase expression in the endometrium of patients diagnosed with endometriosis. Patients and methods. Endometrial biopsies were taken at the time of laparoscopy in 40 patients with endometriosis, 16 of whom were using an oral contraceptive containing gestodene at the time of laparoscopy. The remaining 24 patients were receiving no form of treatment for endometriosis. Endometrial biopsies taken from 23 patients with normal echographic signs and no symptoms were used as controls. Aromatase expression was evaluated in endometrial samples using immunohistochemistry. Results. In the untreated, symptomatic endometriosis patients, aromatase expression was detected during the proliferative phase in 92% of cases, while in the symptom-free control patients aromatase was expressed in only 9% of cases. In patients with endometriosis who were using oral contraceptives, there were significantly fewer cases of positive endometria compared with the untreated patients with endometriosis (6%). Conclusion. Oral contraceptives containing gestodene are effective in decreasing aromatase expression in the eutopic endometrium of patients with endometriosis.

Progressive lesions of Central Nervous System in microcephalic fetuses with suspected congenital Zika virus syndrome

To describe the pattern and progression of central nervous system (CNS) lesions in microcephalic fetuses with suspected Zika virus (ZIKV) infection.

Aromatase expression in the eutopic endometrium of myomatous uteri: The influence of the menstrual cycle and oral contraceptive use

Aims. To detect aromatase expression in the endometrium of myomatous uteri and to correlate it with the location of the myoma, phase of the menstrual cycle, the presence of menorrhagia and oral contraceptive use. Method. Aromatase p450 expression was measured using immunohistochemical methods in the endometrium of 116 patients. Sixty-one patients had menorrhagia associated with intramural/submucous myomas and nine had subserous myomas and no excessive bleeding. Forty-six patients had no uterine pathology and served as controls. Nineteen out of 61 patients with menorrhagia were oral contraceptive users at the time of the examination. Endometrial samples were obtained by hysteroscopy in all cases. Results. Aromatase p450 expression was detected more frequently in the eutopic endometrium of patients with submucous or intramural myomas than in those in the subserous group, and was significantly greater during the proliferative phase than during the luteal phase or following the use of oral contraceptives. In normal uteri, aromatase expression was detected in the endometrium in less than 10% of users. Conclusions. Aromatase expression in the endometrium was affected by the location of the myoma, the presence of symptoms, and the phase of the menstrual cycle. Oral contraceptives, on the other hand, inhibited aromatase expression in the eutopic endometrium of patients with submucous/intramural myomas.

Effect of oral contraceptives on vascular endothelial growth factor Cox-2 and aromatase expression in the endometrium of uteri affected by myomas and associated pathologies.

BACKGROUND The study was conducted to evaluate vascular endothelial growth factor (VEGF), Cox-2 and aromatase expression in the endometrium of uteri with myomas and other associated pathologies. STUDY DESIGN Hysteroscopy was performed in 118 women of reproductive age with myomas and menorrhagia, 40 of whom were using a pill containing 75 mcg gestodene+30 mcg ethinylestradiol. Aromatase p450, VEGF and Cox-2 expression was detected using immunohistochemistry. Fishers Exact Test and the Mann-Whitney test were used in the statistical analysis, with significance established at p<.05. RESULTS In patients with myomas and menorrhagia, associated pathologies such as adenomyosis, endometrial polyps and endometriosis were found in 32%, 12% and 17% of cases, respectively. Aromatase, Cox-2 and VEGF expression was greater during the proliferative phase compared to the luteal phase of the cycle or following oral contraceptive use. CONCLUSION Endogenous progesterone or combined oral contraceptives are potent inhibitors of VEGF, aromatase and Cox-2 expression in the endometrium of patients with myomas and menorrhagia.

Anticorpos antifosfolípides em mulheres com antecedentes de perdas gestacionais: estudo caso-controle

OBJETIVO: determinar a prevalencia de anticorpos antifosfolipides em mulheres com antecedentes de perdas gestacionais na populacao obstetrica em geral e verificar se os anticorpos antifosfolipides representam fator de risco para perdas gestacionais na populacao estudada. METODOS: foi realizado um estudo caso-controle prospectivo com mulheres gravidas e nao gravidas, atendidas numa maternidade publica entre marco de 2003 e junho de 2004. As mulheres foram divididas em dois grupos de acordo com o passado obstetrico; 100 mulheres com antecedentes de perdas gestacionais de acordo com a definicao estabelecida para o diagnostico da sindrome antifosfolipidica e que nao apresentassem outros fatores relacionados ao insucesso gestacional; 150 mulheres saudaveis com antecedentes de duas ou mais gestacoes bem sucedidas. A determinacao do anticoagulante lupico (AL) foi feita mediante os testes de TTPA, dRVVT de triagem e dRVVT confirmatorio. Para a pesquisa dos anticorpos anticardiolipina (aCL) classes IgG e IgM foi utilizado o teste de ELISA. e os resultados semiquantitativos expressos em unidades GPL e MPL. RESULTADOS: o anticoagulante lupico estava presente em 5% das pacientes-caso e 2% dos controles (p=0,27). Os anticorpos aCL IgG estavam presentes em 18% das pacientes-caso e 8,7% das pacientes-controle (p=0,028; OR=2,3; IC 95%=1-53). Na classe IgM, 5% de positividade para os casos e 1% para os controles (p=0,21). CONCLUSOES: os anticorpos antifosfolipides (AL e/ou aCL IgG e/ou IgM) foram mais prevalentes nas mulheres com perdas gestacionais (28%) que na populacao obstetrica em geral (17%). As mulheres com aCL IgG tem duas vezes mais chance de ter perdas gestacionais que a populacao obstetrica em geral.

Acurácia da citologia vaginal e colposcopia para diagnóstico de neoplasia intraepitelial cervical no CICAN-Bahia

Resumo O rastreamento do câncer do colo uterino é realizado por meio da citologia cervical e colposcopia. O objetivo deste estudo foi avaliar a acurácia da citologia cervical e da colposcopia para o diagnóstico de neoplasia intraepitelial cervical no do Centro Estadual de Oncologia. Para tanto, utilizou-se os dados das citologias de 351 pacientes e de 378 colposcopias que também realizaram biópsias de lesões suspeitas. Foram estimadas as medidas de acurácia das citologias e das colposcopias. Os valores da sensibilidade e especificidade para citologia foram de 85,04% (Intervalo de Confiança 95% 80,34 – 89,01), 40% (Intervalo de confiança 95% 28,47 – 52,41), respectivamente; e, para colposcopia, de 97,73% (Intervalo de confiança 95% 95,37 – 99,08) e 15,79% (Intervalo de confiança 95% 8,43 – 25,96), respectivamente. O valor da Razão de Probabilidade positiva da citologia foi de 1,42 (Intervalo de confiança 95%, 1,16 – 1,72) e da Razão de Probabilidade negativa foi de 0,37 (Intervalo de confiança 95%, 0,25 – 0,56). Já para colposcopia, o valor da Razão de Probabilidade positiva foi de 1,16 (Intervalo de confiança 95%, 1,05 – 1,28); e, a Razão de Probabilidade negativa de 0,14 (Intervalo de confiança 95%, 0,06 – 0,36). Assim, sugere-se que a capacidade da citologia e colposcopia de modificar a probabilidade pós-teste de doença no Centro Estadual de Oncologia

Cytogenetic abnormalities in couples with a history of primary and secondary recurrent miscarriage: a Brazilian Multicentric Study

Abstract Objective: To evaluate the difference between chromosomal abnormalities between the gender of couples affected by Recurrent miscarriage (RM) and if there is an association between previous obstetric history and chromosomal abnormalities of the parents. Methods: Multicenter, retrospective, observational study from seven different RM clinics between 2006 and 2016. We enrolled 707 couples (1014 participants) with a history of RM. We compared the frequency of chromosomal abnormalities between groups of couples with primary and secondary RM and separated between women and their partners. Furthermore, we compared the prevalence of chromosomal abnormalities between groups based on the number of previous spontaneous abortions. Results: The overall prevalence of all cytogenetic abnormalities was 5.59% (n = 1414, women and their partners). Excluding cases of polymorphism and inversion of chromosome 9, which are considered variants of normality, the prevalence in all individuals was 2.26% (n = 32/1414). The comparative analysis of cases of chromosomal abnormalities among couples with primary and secondary RM based on the number of previous miscarriages (PM) revealed a similar frequency between groups. The statistical analysis of the total cases (primary PM + secondary PM) in these three groups were as follows: (a) couple, 2 pm versus 3 pm vs. ≥4 PM, p = .514; (b) women, 2 pm versus 3 pm vs. ≥4 PM, p = .347; and (3) partner, 2 pm versus 3 pm vs. ≥4 PM, p = .959. Chromosomal abnormalities were significantly more prevalent among women than among their partners (6.9 versus 4.2%; p = .027). Moreover, the distribution of leading chromosomal abnormalities among women was different compared with their partners. Among women, we observed these abnormalities in the following frequency order: mosaicism (38.8%), polymorphism (32.6%), translocation (16.3%), and inversion (12.3%). Among their partners, these abnormalities were polymorphism (73.3%), inversion (13.3%), mosaicism (6.7%), and translocation (6.7%). Conclusion: The number of PM and the history of full-term pregnancy does not correlate with an increase or decrease in the prevalence of cytogenetic abnormalities in couples with RM.

Lymphocyte immunotherapy for recurrent miscarriages: Predictors of therapeutic success

To evaluate the predictors of successful pregnancies in women with a history of recurrent miscarriages (RMs) having undergone lymphocyte immunotherapy (LIT).