Caracterização da resposta imune celular em mulheres com câncer de ovário

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Histerossonografia em mulheres inférteis candidatas às ténicas de reprodução assistida

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Eficácia da motilidade espermática pós-capacitação e encubação na predição de gravidez

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Correlação ultrassonográfica e histeroscópica no diagnóstico de pólipos endometriais em mulheres na pós-menopausa

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo do fluido folicular, transporte, recuperaçao e maturação de oócitos em éguas superovuladas com estrato de pituitária equina

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Investigação em 20 anos (1990-2009) da doença trofoblástica gestacional em um Centro de Referência da Região Sudeste do Brasil

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Pelvic floor muscle strength evaluation in different body positions in nulliparous healthy women and its correlation with sexual activity

Objective: The aim of this study was to assess pelvic floor muscle (PFM) strength in different body positions in nulliparous healthy women and its correlation with sexual activity.Materials and Methods: Fifty healthy nulliparous women with mean age of 23 years were prospectively studied. Subjective evaluation of PFM was assessed by transvaginal digital palpation (TDP) of anterior and posterior areas regarding the vaginal introitus. A perineometer with inflatable vaginal probe was used to assess the PFM strength in four different positions: supine with extended lower limbs (P1); bent-knee supine (P2); sitting (P3); standing (P4).Results: Physical activity, 3 times per week, was reported by 58% of volunteers. Sexual activity was observed in 80% of women and 82% of them presented orgasm. The average body mass index (BMI) was 21.76 kg/m(2), considered as normal according World Health Organization (WHO). We observed that 68% of volunteers were conscious about the PFM contraction. TDP showed concordance of 76% when anterior and posterior areas were compared (p = 0.00014). There was not correlation between PFM strength and orgasm in subjective evaluation. The PFM strength was significantly higher in standing position when compared with the other positions (p < 0.000). No statistical difference was observed between orgasm and PFM strength when objective evaluations were performed.Conclusions: There was concordance between anterior and posterior areas in 76% of cases when subjective PFM strength was assessed. In objective evaluation, higher PFM strength was observed when volunteers were standing. No statistical correlation was observed between PFM strength and orgasm in nulliparous healthy women.

Biotecnologias aplicadas à reprodução de éguas velhas

The acceptance of biotechnology for the most equine breeders association had a significant effect in the horse industry, gaining popularity around the world, because the increasing on the genetic gain, allowing the use of sub fertile mares and stallions with high genetics value on reproduction. The embryos in vitro production of human and cattle has been used with success, however in vitro embryo production is not efficient in the horse, as oocyte transfer (OT) and intracytoplasmatic sperm injection (ICSI). The oocyte transfer has been used especially in subfertile old mares presenting reproductive pathologies as: endometrite, cervical and uterine adhesions, blocked oviduct, perineal laceration and ovulation failures. During oocyte recovery process, the oocytes must be collected from immature follicles that need be matured in vitro or in vivo matured oocytes from pre-ovulatory follicles through the transvaginal aspiration guided by ultrasound. The recovered oocyte is transferred to a previously inseminated recipient mare, through the flank laparotomy. The intracytoplasmatic sperm injection (ICSI) is a procedure of in vitro fertilization that needs only one sperm that is aspirated and injected inside the oocyte. The oocytes used, can be from mature and immature follicles. Fresh, cooled and frozen semen can be used, because the procedure not requires a functional sperm. The use of Piezo drill resulted in a breakthrough the pellucid zone, allowing the vibration per minute provided in the sperm injection pipette, a major result of cleaved oocytes, due to a better sperm injection in the oocyte. The embryo transfer can be straight inside the oviduct, as also transcervical transferred after embryo culture produced in vitro. In conclusion both procedures (OT and ICSI) are effective to be used on equine assisted reproduction, getting results even lower than expected, but satisfactory from animal genetically superior

Dinâmica folicular ovariana e bases para a aplicação das biotécnicas da reprodução em bovinos

In the last years Brazil has achieved a leading position in worldwide cattle breeding. This country is consolidating the practice of an intensive and technical level cattle breeding, due to greater emphasis on reproductive efficiency and genetic improvement. The attention given to reproductive efficiency became to enhance the genetic improvement process, by exploiting the full reproductive potential of the animals. The biotechniques applied to reproduction arised to expand the reproductive potential for greater economic return. Are the most important reproductive biotechniques the FTAI and in vivo and in vitro embryo production for embryo transfer. Different hormonal treatments are consolidating to interfere with normal physiology in order to achieve the desired goals. The FTAI works to increase the reproductive rates of cattle through pre-booked artificial insemination in all the females in reproduction, without the need for estrous detection. The in vivo and in vitro embryo production aims to distribute the genetics of males and females genetically improved by transferring their embryos to genetically inferior females. Superovulation treatments designed to prevent the mechanism of dominance, which results in many follicles ovulating simultaneously for in vivo embryo production. To the in vitro embryo production, the technique of ovarian puncture guided by transvaginal ultrasound allows to aspirate a number of quality oocytes. The application of biotech is based on knowledge of the female and ovarian reproductive physiology and knowledge of their acting in different breeds and environments.

Reliability of pelvic floor muscle strength assessment in healthy continent women

Background: The aim of this study was to compare pelvic floor muscle (PFM) strength using transvaginal digital palpation in healthy continent women in different age groups, and to compare the inter- and intra-rater reliability of examiners performing anterior and posterior vaginal assessments.Methods: We prospectively studied 150 healthy multiparous women. They were distributed into four different groups, according to age range: G1 (n = 37), 30-40 years-old; G2 (n = 39), 41-50 years-old; G3 (n = 39), 51-60 years-old; and G4 (n = 35), older than 60 years-old. PFM strength was evaluated using transvaginal digital palpation in the anterior and posterior areas, by 3 different examiners, and graded using a 5-point Amaro's scale.Results: There was no statistical difference among the different age ranges, for each grade of PFM strength. There was good intra-rater concordance between anterior and posterior PFM assessment, being 64.7%, 63.3%, and 66.7% for examiners A, B, and C, respectively. The intra-rater concordance level was good for each examiner. However, the inter-rater reliability for two examiners varied from moderate to good.Conclusions: Age has no effect on PFM strength profiles, in multiparous continent women. There is good concordance between anterior and posterior vaginal PFM strength assessments, but only moderate to good inter-rater reliability of the measurements between two examiners.

Evaluation of clinical, ultrasonographic and hysteroscopic parameters in the differentiation of endometrial polyps and cancer of endometrium

Study Objective: To evaluate the diagnostic accuracy of transvaginal ultrasound and office hysteroscopy in the differentiation between endometrial polyps and endometrial adenocarcinoma. Design: This is a prospective 100 women longitudinal study, 24 to 80 years, submitted to hysteroscopic polypectomy (n = 80) or surgery due to endometrial adenocarcinoma (n = 20), from january 2010 to December 2011. Clinical, ultrasonographic and hysteroscopic parameters were analyzed and compared with histopathologic find. Statistical analysis were performed utilizing the Tukey, Kruskal-Wallis, Dunn and Mann-Whitney test, with a confidence interval of 95% and p\0, 05 statiscally significant. Setting: Botucatu Medical School. Intervention: Prospective analysis of clinical, ultrasonographic and hysteroscopic parameters in patients with diagnosis suspected of endometrial polyps and adenocarcinoma of endometrium were performed. According to the diagnosis, hysteroscopic polypectomy or pan hysterectomy with lymph node sampling was realized. After the surgery and histopathological study, statistical analysis of parameters was performed and the results were compared between groups. It was Research Ethics Committee approved. Measurements and Main Results: There were no differences between age, BMI, menopause, TH use and associated diseases among groups. The main symptom of endometrial cancer was the postmenopausal bleeding, affecting 84,2% of women against 34,8% of polypectomy group. The majority of women with endometrial polyps were asymptomatic. Transvaginal ultrasonography showed no ability to differentiate cases of endometrial cancer compared with the cases of endometrial polyps, considering the presence of endometrial thickness and blood flow on color Doppler. Office hysteroscopy showed significant changes in 75% of the adenocarcinoma cases, especially the presence of diffuse hypervascularity with atypical vessels. Conclusion: Still remains an inability to establish clinical parameters and reliable ultrasound imaging to differentiate endometrial polyps and cancer of endometrium. Attention should be given to hysteroscopic exams presenting diffuse endometrial hypervascularization with architectural distortion of the vessels. The recommendation of our service remains the systematic removal of all endometrial polyps.

Avaliação da cavidade uterina com histerossonografia, uma revisão

Sonohysterography was firstly described three decades ago. The saline solution infusion into the uterine cavity favors its use and provides excellent visualization of the anatomy and the inner cavity of the uterus better than the conventional transvaginal sonography To check the current role of sonohysterography in the uterine cavity assessment in women with abnormal uterine bleeding and asymptomatic, a literature review comparing sonohysterograph with conventional transvaginal sonography and/or ambulatory diagnostic hysteroscopy was carried out. To this end, relevant studies were researched in electronic databases Medline/PubMed, SciELO/LILACS. The sonohysterography is an ambulatory procedure, non-invasive, better cost-benefit, better sensitivity and specificity to identify uterine abnormalities, causing minimal discomfort and low complications rate. It was subject to revision which there is no more doubt about its accuracy. It can be concluded that the sonohysterography is a useful tool in the propedeutics to assess uterine cavity of symptomatic patients with abnormal uterine bleeding, infertility, recurrent miscarriages, and embryonic implantation failures in assisted reproduction treatment / in vitro fertilization and in any other intra and extra uterine cavity alteration. Hence, conventional transvaginal sonography is indicated as an initial method of assessment of the uterine cavity previously to ambulatory diagnostic hysteroscopy.