Maurício Mesquita Sabino de Freitas

REVIEWS: The Effects of Hypoestrogenism on the Vaginal Wall: Interference with the Normal Sexual Response

INTRODUCTION The sexual response depends on the adequate function of all systems related to the genital and extra-genital organs. Physiological conditions such as menopause can interfere with sexual expression because of central and peripheral changes. Genital effects of estrogen include vaginal trophism, lubrication, and local pleasure sensation in the sexual arousal phase. Hypoestrogenism causes changes in the four layers of the vaginal wall that may result in dyspareunia and a loss in the quality of the genital arousal response. AIM The purpose of this review is to highlight the changes in the vaginal wall caused by hypoestrogenism, its possible relationship with dyspareunia, and its repercussions for genital arousal. Treatments for hypoestrogenism are also discussed. METHODS We evaluated the data available in PubMed (1982-2008) and surveyed the reference list for relevant studies. Two reviewers analyzed the data independently. A study was considered to be of high quality if it had all three of the following characteristics: (i) prospective design; (ii) valid data; and (iii) adequate sample size. Reviews and experimental animal studies were also considered. MAIN OUTCOME MEASURES Normal genital morphology, hypoestrogenism and hormone replacement therapy were the focus of the studies reviewed in this paper. RESULTS Atrophy of the vaginal wall may be associated with dyspareunia and genital sexual arousal disorder, but psychological and sociocultural aspects must also be considered. Regardless, however, local estrogen therapy is useful in improving vaginal wall trophism and, thus, in improving the sexual response. CONCLUSIONS There are many possible alterations in the structure of the vaginal wall that are related to estrogen deficiency that may require medical intervention beyond the usual strategies used to attain adequate sexual function. Physicians should attempt to treat these alterations, and more research is needed to elucidate the physiopathology of dyspareunia and genital sexual arousal physiology.

Retinal changes and tumorigenesis in Ramon syndrome : Follow-up of a Brazilian family

We report on the clinical evolution of the Brazilian family with Ramon syndrome described by de Pina-Neto et al. [1986, Am J Med Genet 25:441-443]. Three members (patients IV-2, IV-18, and IV-19) have developed pigmentary changes in the retina and paleness of the optic disk. Patient IV-18 also has developed giant hypertrophy of the labia minora that, when examined histopathologically, was found to be due to neoplastic fibroblast and epithelial proliferation caused by a fibromatous process similar to that reported in the gingivae of the patients with this syndrome. Audiologic function of patient IV-2 was normal, and no skin lesions were detected. The articular signs and symptoms show that the affected relatives developed rheumatoid arthritis, which is currently inactive in patient IV-18, whereas patient IV-2 did not develop these alterations.

Pulmonary tumor embolism from squamous cell carcinoma of the vulva

Involvement of the pulmonary vessels by tumor emboli has been described from different primary sites of malignancy. A case of pulmonary tumor embolism due to squamous cell carcinoma of the vulva is reported. This form of pulmonary involvement has not previously been described in cases of vulvar carcinoma and it is rare in gynecologic neoplasms. The development of dyspnea with rapid clinical deterioration and fatality associated with multiple pulmonary emboli and histologic signs of pulmonary hypertension is well shown by this case.

Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial

Trata-se de um ensaio clinico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulacao transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinaria em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinencia urinaria (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionario de QV generico, o Medical Outcomes Study Short Form 36 (SF-36) e um questionario especifico para IU, o Incontinence Quality of Life Instrument (I-QOL). Os relatos de perdas urinarias e incomodos ocasionados foram avaliados, respectivamente, por meio do diario miccional de 24 horas e Escala Visual Analogica (EVA). O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em tres dominios do I-QOL, na EVA, que avaliou o grau de incomodo causado pela IU e em quatro aspectos do diario miccional. No grupo de ET houve melhora significativa de dois dominios do SF-36, tres dominios do I-QOL, na EVA e em quatro aspectos do diario. Houve melhora da QV em ambos os grupos, assim como uma diminuicao das queixas de perda urinaria, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois dominios do questionario de QV generico apos o tratamento, que teve limitacao por aspectos fisicos e limitacao por aspectos emocionais. O que nao ocorreu com o grupo de ENT.

Double Uterus Associated with Unilateral Renal Agenesis and Ipsilateral Blind Vagina

Abstract Five cases of double uterus associated with unilateral renal agenesis and ipsilateral blind vagina are presented. The patients complained of chronic or recurrent, fetid vaginal secretion. One of the patients was diagnosed at 4 years of age. Laparotomy revealed the presence of an atretic ureter or wolffian duct remnants in 4 cases; a communication with the blind vagina was present in 3.

Evaluation of staging, cytoreduction and second-look operation of 119 ovarian cancer patients

OBJECTIVE This study was conducted on patients with ovarian cancer in order to evaluate survival. DESIGN A retrospective study of 119 cases of ovarian cancer from January 1977 to December 1992 with observation until 1993. LOCATION Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, São Paulo University. PARTICIPANTS Of the 119 cases, 70 (58.8%) presented epithelial carcinomas and 21 (17.6%) tumors of the sexual girdle/stroma. DATA SOURCE The data were obtained from the medical records of the patients. MEASUREMENT Statistical analysis of survival time was based on the nonparametric Mann-Whitney test with the level of significance set at P < 0.05. RESULTS The patients with a negative second look had a mean survival of 79.4 +/- 48.5 months versus 24.2 +/- 15.1 months for patients with a positive second look (P < 0.02). CONCLUSIONS It is concluded that patients with a negative second look present a better prognosis compared to those with residual disease.