Vilmon de Freitas

P27Kip1 is down-regulated in the endometrium of women with endometriosis

OBJECTIVE To evaluate p27 protein expression in the endometrium of women with endometriosis. DESIGN Transversal case-control study. SETTING Endometriosis Unit, Federal University of São Paulo, Brazil. PATIENT(S) Thirteen patients with stage I/II endometriosis, five with stage III/IV endometriosis, and 11 control subjects. INTERVENTION(S) Endometrial biopsies were obtained from patients with proven endometriosis and women without disease at laparoscopy. P27 protein was immunolocalized in the biopsy tissues and quantified by light microscopy. MAIN OUTCOME MEASURE(S) Immunostaining scores of glandular and stromal cells in endometrial biopsies obtained from patients with confirmed endometriosis compared with those of healthy control women with normal pelvis at laparoscopy. The staining scores of stage I/II and stage III/IV patients and of both patient groups and the control group were compared. RESULT(S) The level of p27 protein expression observed in the control group, both in the stroma and in the endometrial glands, was significantly different from that observed in the endometriosis patient groups. Significant differences in p27 protein expression levels in the glandular epithelium and stroma were not observed among groups of patients with endometriosis. CONCLUSION(S) The decreased level of p27 protein in the endometrium of women with endometriosis suggests that cell cycle alterations in the endometrial mucosa may be involved in the pathogenesis of this disease.

Genetic analysis of the cause of endometrial osseous metaplasia.

OBJECTIVE: To analyze solitary bone fragments from the uterine cavity through DNA genotyping, thus elucidating whether they originate from metaplasia, from previous abortion, or both. METHODS: We conducted a case series study on 14 patients, of whom eight yielded bone DNA. The patients selected had histopathologic diagnoses of bone fragments inside the uterine cavity or previously removed samples available for analysis. We extracted DNA from blood and bone fragments. To identify the bone tissue origin, these materials were genotyped using polymerase chain reactions for DNA loci. Six mini short tandem repeat loci frequently used for human tissue identification were analyzed using automated sequencing. RESULTS: Among these eight patients, blood and tissue samples from the same individual produced exactly the same pair of alleles for all six loci. This indicated that the DNA profile was completely the same for the bone samples and the mother’s blood (95% confidence interval 63–100%), thus confirming that the DNA had the same origin and that these were cases of metaplasia. CONCLUSION: In all of the eight cases, bone formation was caused by osseous metaplasia, because the DNA in the bone fragment and in the patient’s blood was identical. Although all of the women had histories of previous abortion, no difference in DNA was detected in the bone tissue in any of the cases, as would be expected if abortion had occurred. This result was completely unexpected, differing greatly from what the literature suggests. LEVEL OF EVIDENCE: III

Endometriose: modelo experimental em ratas

Purpose: to demonstrate the experimental endometriosis induction in animals. Method: we used adult female Wistar rats weighing 200 - 250 g anesthetized with ethyl ether to open the abdominal cavity. After identifying the uterine horns, we removed an approximately 4 cm fragment from the right uterine horn. This fragment was placed in physiological saline and, with the aid of a stereoscopic magnifying glass, the endometrium was separated from the myometrium and cut into rectangles of approximately 4 x 5 mm. These rectangles were fastened to the lateral abdominal wall near great blood vessels, taking care that the free portion of the endometrium was directed towards the lumen of the abdominal cavity. After 21 days the animals were again operated to observe the size of the implants and to remove the ectopic endometrium for microscopic analysis. Results: we macroscopically observed a significant growth of the endometrial implants. Microscopic examination showed presence of glandular epithelium and stroma similar to topic epithelium. Conclusion: this model reproduces endometriosis in the female rat allowing a better study of this pathology, mainly the action of drugs on these implants.

Estados emocionais de casais submetidos à fertilização in vitro

Infertility intrudes into the plans in ones personal life and the life of a couple, and causes mental suffering. In vitro fertilization is a new technique in reproductive technology and offers fresh hope of having children, but at the same time, it is considered to be a stressful experience. The aim of this study is to compare the emotional state of men and women undergoing in vitro fertilization and identify a possible relationship between womens emotional state and a successful outcome. Twenty couples in their first cycle of in vitro fertilization were included in this study. Men and women were submitted individually to psychological interviews and tests between 5 and 10 days after the transfer of pre-embryos. Women presented higher levels of anxiety and depression than men. Their self-esteem proved to be lower. Those women (25%) that presented psycho-emotional symptoms, did not get pregnant, however this relationship was not significant. Based on these findings, we conclude that women presented greater anxiety and symptoms of depression than the men and had lower self-esteem. The group of women with psycho-emotional symptoms displayed a tendency not to get pregnant.

Morphological action of tamoxifen in the endometrium of persistent estrous rats

Background. The aim of this study was to evaluate the action of tamoxifen on the endometrium in states of chronic anovulation.

Metaplasia óssea endometrial: quadro clínico e seguimento após tratamento

PURPOSE to describe the clinical signs and symptoms of patients with bone metaplasia and to assess the risk factors for changes in these symptoms after removal of the bone fragment. METHODS a cross-sectional study was conducted on 16 patients with a diagnosis of bone fragments in the uterine cavity during the period comprising July 2006 to January 2009. The inclusion criterion was the detection of a bone fragment removed from the uterine cavity. The presence of bone tissue in the endometrial cavity was histologically confirmed in all patients. The data of all patients were obtained before and after removal by means of a questionnaire for the evaluation of the effect of removal on the symptoms and for the search of possible factors related to the onset of the disease. RESULTS half the patients (8/16) had hemorrhagic symptoms and one third (6/16) were infertile. Removal of the fragments was quite effective in improving the complaints, with the disappearance of symptoms in all cases of hemorrhage and of pelvic pain. CONCLUSION removal of bone fragments can restore the fertility of selected patients whose infertility is caused by bone metaplasia and is quite effective in leading to improvement in patients with pelvic pain and menorrhage.

Ultrasonographic and morphological studies of the postmenopausal endometrium using unopposed estrogen replacement therapy with regular pause: a prospective preliminary study

UNLABELLED Hormone replacement therapy with progestogen is known to have severe side effects or complications in certain patients. OBJECTIVE The goal of this study is to evaluate the safety and efficacy of an alternative treatment regimen with a mensal pause using both transvaginal sonography (TVS) and endometrial biopsy to follow patients. METHODS A total of 30 postmenopausal women were treated with unopposed estrogen for 21 days each month followed by a regular pause of 9-10 days, and were studied prospectively for 18 months. The TVS measurements of endometrial thickness and biopsy of the endometrium were done on the 21st day of treatment and the 7th day of the pause at 6-month intervals throughout the study. RESULTS There was a significant decrease of proliferative activity at all three time points during the study (6, 12 and 18 months) when tested on the 7th pause day (PD7). The percentage of patients with hyperplasia without nuclear atypia and endometrial thickness > or =8mm was 32% at 6 months, but decreased to 22 and 19% at 12 and 18 months, respectively. All cases of hyperplasia regressed after the hormonal pause throughout the treatment period. CONCLUSIONS This study presents an alternative treatment regimen for select patients having side effects or complications from progestogen administration; however, studies evaluating the safety and efficacy of this regimen over longer time periods are necessary.

Peritoneal fluid modulates the sperm acrosomal exocytosis induced by N-acetylglucosaminyl neoglycoprotein

The effect of peritoneal fluid (PF) on the human sperm acrosome reaction (AR) was tested. Sperm was pre-incubated with PF and the AR was induced by calcium ionophore A23187 and a neoglycoprotein bearing N-acetylglycosamine residues (NGP). The AR induced by calcium ionophore was inhibited 40% by PF from controls (PFc) and 50% by PF from the endometriosis (PFe) group, but not by PF from infertile patients without endometriosis (PFi). No significant differences were found in the spontaneous AR. When the AR was induced by NGP, pre-incubation with PFc reduced (60%) the percentage of AR, while PFe and PFi caused no significant differences. The average rates of acrosome reactions obtained in control. NGP- and ionophore-treated sperm showed that NGP-induced exocytosis differed significantly between the PFc (11%) and PFe/PFi groups (17%), and the ionophore-induced AR was higher for PFi (33%) than PFc/PFe (25%). The incidence of the NGP-induced AR was reduced in the first hour of pre-incubation with PFc and remained nearly constant throughout 4 h of incubation. The present data indicate that PF possesses a protective factor which prevents premature AR.

Schistosoma mansoni pseudo-cyst as a cause of chronic pelvic pain.

A case of mansoni schistosomiasis causing peritoneal inflammation and chronic iliac pain is reported. The patient complained of iliac pain for 6 months. Physical examination and sonographic evaluation found a tumor in the left iliac fosse. A pseudocyst was removed from the pelvic region. The histopathology confirmed the diagnosis of S. mansoni. This is a rare case of S. mansoni in the pelvic cavity.

Effects of estrogen replacement isolated and associated with gestrinone in oophorectomized adult rats with experimental endometriosis

Objective: The aim of this work was to analyze the effects of conjugated equine estrogens and gestrinone in oophorectomized adult rats previously submitted to endometrial implants. Study Methods: 50 adult female rats in which an endometrial implantation was made on the lateral abdominal wall. After four weeks a new laparotomy was achieved where implant sizes were measured, followed by bilateral oophorectomy. After six weeks, the animals were randomly divided into five groups: G I (n=lO) received 0,5 muday of propylenoglycol (control), GII (n=lO) received CEE (50 pgiday), GIII (n=lO) received CEE (25 pgiday), G IV (n = 10) received CEE (25 pgiday) associated with gestrinone (2,5 pgiday); GV (n = 10) received CEE (50 pgiday) associated with gestrinone (2,5 pgiday). All animals were daily treated for 21 consecutive days by subcutaneous route. After this period the animals were submitted to a new laparotomy and the implants were measured and resected for light microscopy analysis. Results: The results showed a meaningful growth of endometrial implants group GII, which presented as vesicles with clear liquid content. Light microscopy showed the presence of endometrial tissue containing stroma, glands and well-developed cysts. There was regression of implant in groups GI, GIII, GIV and GV, and its localization was possible only due to the presence of surgical material. Conclusion: Only 5Opg CEE promote growth of endometrial implants and gestrinone opposed the CEE effects.