Hydatidiform mole resulting from sexual violence

Background. Hydatidiform mole (HM) is characterized by abnormal proliferation of human trophoblast with producers functioning tissues of human chorionic gonadotropin. It can evolve with ovarian cysts tecaluteínicos, hypertension of pregnancy or hyperthyroidism. The incidence of HM is variable and its etiology poorly known, associated with nutritional factors, environmental, age, parity, history of HM, oral contraceptives, smoking, consanguinity or defects in germ cells. There is no reference in literature on HM resulting from sexual violence, objective of this report. Method. Description of two cases of HM among 1146 patients with pregnancy resulting from sexual violence treated at Hospital Pérola Byington, São Paulo, from July 1994 to August 2011. Results. The cases affected young, white, unmarried, low educated and low parity women. Sexual violence was perpetrated by known offenders unrelated to the victims, under death threat. Ultrasound and CT of the pelvis showed bulky uterus compatible with HM without myometrial invasion. One case was associated with theca lutein cysts. The two cases were diagnosed in the second trimester of pregnancy and evolved with hyperthyroidism. There was no hypertension, disease recurrence, metastasis or sexually transmitted infection. Conclusion. The incidence of HM was 1:573 pregnancies resulting from rape, within the range estimated for Latin American countries. Trophoblastic material can be preserved to identify the violence perpetrator, considering only the paternal HM chromosomes. History of sexual violence should be investigated in cases of HM in the first half of adolescence and women in a vulnerable condition. © 2012 Drezzet et al; licensee BioMed Central Ltd.

Avaliação endócrina e anatomo-morfológica do trato genital de fêmeas suínas

Pós-graduação em Medicina Veterinária - FMVZ

Avaliação da técnica de aspiração ovocitária transvaginal (Ovum Pick Up) e produção in vitro de embriões da raça nelore (Bos taurus indicus) oriundos de doadoras com alterações da fertilidade

Este experimento teve como objetivo avaliar a possibilidade da utilização de fêmeas zebuínas de elevada qualidade genética, com problemas de fertilidade, adquiridos após um programa de transferência convencional de embriões, como doadoras de ovócitos em um programa de Ovum Pick Up e Produção In Vitro de embriões. Fêmeas da raça Nelore (n=16) (Bos taurus indicus), com idade média de 11 anos e 7 meses, foram submetidas às mesmas condições de ambiente, alimentação e manejo. Estes animais foram retirados do programa de T.E. por apresentarem problemas de fertilidade (cistos ovarianos, infecções genitais, mucometra e alguns casos de repetições de cio sem causa aparente). Os animais foram divididos em dois grupos conforme o tipo de patologia: GRUPO I (n=08) composto por animais que apresentaram patologias ovarianas (cistos) e GRUPO II (n=08) formado por animais com patologias extra ovarianas, ambos os grupos foram submetidos à aspiração folicular (OPU) utilizando dois tipos de agulhas (21G ; 19G ) e pressões (55 e 70mmHg) divididos em quatro tratamentos (T1 = 55/21G; T2 = 55/19G; T3 = 70/21G e T4 = 70/19G), posteriormente os ovócitos submeteramse a PIV. Foram realizadas 149 aspirações e colhidos 879 ovócitos (5,9 4,88) onde GRAU I = 16%; GRAU II = 43%; GRAU III = 21% e GRAU IV = 20%. As médias de ovócitos colhidos no GRUPO I foram (T1 = 7,06 5,10; T2= 7,00 3,64; T3 = 10,60 6,51 e T4 = 2,78 2,59) para os animais pertencentes ao GRUPO II obteve-se (T1= 4,90 4,47; T2= 2,93 3,05; T3 = 6,11 4,11 e T4 = 2,70 2,00). Para as médiasde ovócitos viáveis os resultados foram os seguintes: (T1 = 4,35 3,01; T2 = 4,88 2,96; T3 = 6,87 3,91 e T4 = 1,89 1,90) para o GRUPO I e (T1 = 2,70 2,22; T2 =1,92 1,98; T3 = 3,47 2,27 e T4 = 2,00 1,05) para o GRUPO II. Neste experimento foram levados à PIV 538 ovócitos dos quais 161 (32,85%) clivaram e 65 (13,26%) resultaram em Mórula ou Blastocistos. A análise estatística dos resultados não demonstrou diferença significativa entre os grupos quanto a colheita ovocitária. Quando analisada somente a pressão de sucção, foi observado que o tipo de agulha está diretamente relacionado a pressão da bomba de vácuo. Os melhores resultados foram obtidos com o tratamento T3 = 70/21G, além disso pode-se observar que as melhores médias de ovócitos colhidos foram as obtidas no grupo de animais que apresentaram cistos ovarianos (GRUPO I). Desta forma, concluímos neste experimento que a utilização da técnica de OPU/PIV é uma alternativa de grande utilidade no prolongamento da vida reprodutiva de animais zebuínos com alterações na fertilidade.

Prevalência de alterações clínicas e histopatológicas do sistema genital de búfalas (Bubalus bubalis) no Estado do Amapá

Com o objetivo de se verificar a prevalência das enfermidades causadoras da infertilidade, examinaram-se clinicamente 895 búfalas, procedentes do município de Cutias do Araguari, Estado do Amapá. Realizaram-se exames ginecológicos e testes para detecção de tuberculose e brucelose, e analisaram-se 1000 peças de genitais de búfalas abatidas em matadouro. A prevalência de tuberculose e brucelose a nível de campo foi de 9,33% e 9,11%, respectivamente. Das 895 búfalas examinadas, 299 (33,41%) encontravam-se gestantes, sendo que 188 (62,88%) no corno direito e 111 (37,12%) no corno esquerdo. No grupo de búfalas com alterações, foram constatadas os seguintes distúrbios: a) alterações ovarianas: ovários afuncionais, 75 (8,37%); cisto folicular, 6 (0,67%); b) alterações no oviduto: aderências focais, 24 (2,9%); aderências difusas, 22 (2,46%); hidrossalpinge, 8 (0,9%); c) alterações no útero e cérvice: endometrite crônica suave, 5 (0,56%); endometrite crônica moderada, 7 (0,78%); cérvice irregular, 14 (2,9%); d) alterações da vulva e da vagina: vulva dilacerada, 9 (1,1%) num total de 172 (19,21%) vacas com alguma alteração. Nas análises realizadas em matadouro foram evidenciadas 661 (66,10%) animais gestantes, sendo que destes 86 (8,6%) apresentavam alguma alteração e 339 (33,9%) animais não gestantes, sendo 74 (7,4%) com alguma alteração. Das 661 gestantes, 412 (62,3%) foram do corno direito e 249 (37,7%) do corno esquerdo. As alterações encontradas foram: a) alterações ovarianas: ovários afuncionais, 16 (1,6%); cisto para-ovárico, 5 (0,5%); cisto de inclusão epitelial, 8 (0,8%); cisto folicular, 1 (0,1%); b) alterações da tuba uterina: hidrossalpinge, 18 (1,8%); cisto tubo-ovárico, 5 (0,5%); aderências focais, 70 (7,0%); aderências difusas, 21 (2,1%); c) alterações do útero e cérvice: endometrites, 9 (0,9%); perimetrite, 3 (0,3%); adenomiose, 1 (0,1%); aplasia segmentar do útero, 1 (0,1%); gestação gemelar, 1 (0,1%); cérvice irregular, 1 (0,1%). A maior porcentagem de fetos estavam no terço final da gestação com 236 (35,65%) casos. Pode-se concluir que inúmeros são os problemas que podem afetar a fertilidade das búfalas e que cabe uma identificação destes para resolver problemas de produtividade do rebanho.

Hydatidiform mole resulting from sexual violence

Abstract Background Hydatidiform mole (HM) is characterized by abnormal proliferation of human trophoblast with producers functioning tissues of human chorionic gonadotropin. It can evolve with ovarian cysts tecaluteínicos, hypertension of pregnancy or hyperthyroidism. The incidence of HM is variable and its etiology poorly known, associated with nutritional factors, environmental, age, parity, history of HM, oral contraceptives, smoking, consanguinity or defects in germ cells. There is no reference in literature on HM resulting from sexual violence, objective of this report. Method Description of two cases of HM among 1146 patients with pregnancy resulting from sexual violence treated at Hospital Pérola Byington, São Paulo, from July 1994 to August 2011. Results The cases affected young, white, unmarried, low educated and low parity women. Sexual violence was perpetrated by known offenders unrelated to the victims, under death threat. Ultrasound and CT of the pelvis showed bulky uterus compatible with HM without myometrial invasion. One case was associated with theca lutein cysts. The two cases were diagnosed in the second trimester of pregnancy and evolved with hyperthyroidism. There was no hypertension, disease recurrence, metastasis or sexually transmitted infection. Conclusion The incidence of HM was 1:573 pregnancies resulting from rape, within the range estimated for Latin American countries. Trophoblastic material can be preserved to identify the violence perpetrator, considering only the paternal HM chromosomes. History of sexual violence should be investigated in cases of HM in the first half of adolescence and women in a vulnerable condition.

Morfologia das células intersticiais de ovários policísticos de ratas: um estudo experimental

OBJETIVOS: Avaliar a histomorfometria das células intersticiais dos ovários, bem como analisar a concentração sanguínea de esteroides sexuais de ratas portadoras de ovários policísticos induzidos pela luz contínua. MÉTODOS: Vinte ratas foram divididas em dois grupos: ratas na fase de estro (GCtrl ) e ratas portadoras de ovários policísticos induzidos pela iluminação contínua (GOP). Os animais do GCtrl permaneceram com período de luz das 7:00 s 19:00 horas, e os animais do GOP, com iluminação contínua (400 Lux), durante um período de 60 dias. Ao final desse período todos os animais foram anestesiados, foi coletado o sangue, para determinação dos níveis séricos de estradiol (E2), progesterona (P4) e testosterona (T), seguido da retirada dos ovários que foram fixados em formol a 10% e processados para inclusão em parafina. Cortes histológicos com 5 µm corados pela hematoxilina e eosina foram utilizados para análise histomorfométrica. As análises morfológicas, contagem de cistos, determinação da concentração e do volume nuclear das células intersticiais foram realizadas com o auxílio de microscópio de luz adaptado a uma câmera de alta resolução (AxioCam), cujas imagens foram transmitidas e analisadas em computador com software AxioVision Rel 4.8 (Carl Zeiss). Os dados obtidos foram submetidos ao teste t de Student (p<0,05). RESULTADOS: A morfologia mostrou a presença de cistos nos ovários pertencentes ao Grupo OP e de corpos lúteos no GCtrl, mostrando ainda evidências da origem das células intersticiais a partir das células da teca interna desses cistos. Com relação aos níveis hormonais o GOP apresentou níveis séricos de estradiol (pg/mL) aumentados em relação ao GCtrl (GOP=124,9±4,2>GCtrl=73,2±6,5; p<0,05), o mesmo ocorrendo com os níveis de testosterona (pg/mL) (GOP=116,9±4,6>GCtrl=80,6±3,9; p<0,05). Entretanto os níveis de progesterona (ng/mL) foram mais elevados no GCtrl em relação ao GOP (GCtrl=16,3±2,0>GOP=4,2±1,5; p<0,05). A morfometria mostrou haver aumento significante do volume nuclear no grupo GOP (GOP=102,1±5,2>GCtrl=63,6±16,5; p<0,05), assim como da área ocupada (%) pelas células intersticiais (GOP=24,4±6,9>GCtrl=6,9±3,2; p<0,05) em relação aos animais do GCtrl. CONCLUSÃO: As células intersticiais do ovário policístico da rata provavelmente provêm dos cistos ovarianos devido degeneração das células da granulosa e diferenciação das células da teca interna. As elevações dos níveis séricos de testosterona e de estradiol provavelmente provêm do aumento significativo da atividade celular e da área ocupada pelas células intersticiais.

Characterization of a novel CYP19A1 (aromatase) R192H mutation causing virilization of a 46,XX newborn, undervirilization of the 46,XY brother, but no virilization of the mother during pregnancies.

BACKGROUND P450 aromatase (CYP19A1) is essential for the biosynthesis of estrogens from androgen precursors. Mutations in the coding region of CYP19A1 lead to autosomal recessive aromatase deficiency. To date over 20 subjects have been reported with aromatase deficiency which may manifest during fetal life with maternal virilization and virilization of the external genitalia of a female fetus due to low aromatase activity in the steroid metabolizing fetal-placental unit and thus high androgen levels. During infancy, girls often have ovarian cysts and thereafter fail to enter puberty showing signs of variable degree of androgen excess. Moreover, impact on growth, skeletal maturation and other metabolic parameters is seen in both sexes. OBJECTIVE AND HYPOTHESIS We found a novel homozygous CYP19A1 mutation in a 46,XX girl who was born at term to consanguineous parents. Although the mother did not virilize during pregnancy, the baby was found to have a complex genital anomaly at birth (enlarged genital tubercle, fusion of labioscrotal folds) with elevated androgens at birth, normalizing thereafter. Presence of 46,XX karyotype and female internal genital organs (uterus, vagina) together with biochemical findings and follow-up showing regression of clitoral hypertrophy, as well as elevated FSH suggested aromatase deficiency. Interestingly, her older brother presented with mild hypospadias and bilateral cryptorchidism and was found to carry the same homozygous CYP19A1 mutation. To confirm the clinical diagnosis, genetic, functional and computational studies were performed. METHODS AND RESULTS Genetic analysis revealed a homozygous R192H mutation in the CYP19A1 gene. This novel mutation was characterized for its enzymatic activity (Km, Vmax) in a cell model and found to have markedly reduced catalytic activity when compared to wild-type aromatase; thus explaining the phenotype. Computational studies suggest that R192H disrupts the substrate access channel in CYP19A1 that may affect binding of substrates and exit of catalytic products. CONCLUSION R192H is a novel CYP19A1 mutation which causes a severe phenotype of aromatase deficiency in a 46,XX newborn and maybe hypospadias and cryptorchidism in a 46,XY, but no maternal androgen excess during pregnancy.

A CASE-CONTROL STUDY OF RISK FACTORS FOR ECTOPIC PREGNANCY (ROCHESTER, MINNESOTA, OBSTETRICS)

A population-based case-control study of risk factors for ectopic pregnancy has been conducted. The investigation includes 274 cases diagnosed in Rochester, Minnesota residents from 1935 through 1982, and 548 matched controls selected from live birth deliveries. Risk factor information documented prior to the last index menstrual period was obtained via medical record abstract for 22 potential risk factor variables.^ Univariate matched analyses revealed nine variables with significantly elevated odds ratios (ORs). Following conditional logistic regression for matched sets, four variables remained as significant risk factors for ectopic pregnancy. These risk factors with ORs and 95% confidence intervals (Cls) were: current intrauterine device use (OR = 13.7, Cl = 1.6 - 120.6), infertility (OR = 2.6, Cl = 1.6 - 4.2), pelvic inflammatory disease (OR = 3.3, Cl = 1.6 - 6.6), and tubal surgery (OR = 4.5, Cl = 1.5 - 13.9). After adjusting for these four major risk factors, the following variables did not have statistically significant ORs: abdominal/pelvic surgery (OR = 2.0), acute appendicitis (OR = 2.0), anovulation (OR = 1.2), clomiphene citrate use during the index conception (OR = 3.5), induced abortion (OR = 2.1), in utero exposure to diethylstilbestrol (OR = 1.6), myomas (OR = 0.7), ovarian cysts (OR = 1.0), and past intrauterine device use (OR = 1.2). ^

Relationships of Efficiency to Reproductive Disorders in Danish Milk Production: A Stochastic Frontier Analysis

Relationships of various reproductive disorders and milk production performance of Danish dairy farms were investigated. A stochastic frontier production function was estimated using data collected in 1998 from 514 Danish dairy farms. Measures of farm-level milk production efficiency relative to this production frontier were obtained, and relationships between milk production efficiency and the incidence risk of reproductive disorders were examined. There were moderate positive relationships between milk production efficiency and retained placenta, induction of estrus, uterine infections, ovarian cysts, and induction of birth. Inclusion of reproductive management variables showed that these moderate relationships disappeared, but directions of coefficients for almost all those variables remained the same. Dystocia showed a weak negative correlation with milk production efficiency. Farms that were mainly managed by young farmers had the highest average efficiency scores. The estimated milk losses due to inefficiency averaged 1142, 488, and 256 kg of energy-corrected milk per cow, respectively, for low-, medium-, and high-efficiency herds. It is concluded that the availability of younger cows, which enabled farmers to replace cows with reproductive disorders, contributed to high cow productivity in efficient farms. Thus, a high replacement rate more than compensates for the possible negative effect of reproductive disorders. The use of frontier production and efficiency/ inefficiency functions to analyze herd data may enable dairy advisors to identify inefficient herds and to simulate the effect of alternative management procedures on the individual herd's efficiency.

É simples o que faço com os quistos simples do ovário

É cada vez mais frequente o diagnóstico de quisto do ovário pelo uso crescente de exames radiológicos. É essencial a distinção entre quisto simples e quisto complexo, pois a sua abordagem é diferente, sendo o algoritmo de abordagem adaptado à mulher pré- ou pós-menopáusica [1]. A recomendação inicial a seguir varia em função do tamanho da lesão e do valor do CA 125.

Efeitos ginecológicos do "tamoxifeno": contributo da radiologia

O “Tamoxifeno” (TAM) é a terapêutica anti-estrogénica de escolha nas doentes com cancro da mama. Os efeitos proliferativos do TAM em idade pós-menopausa têm sido associados a hiperplasia, pólipos, carcinoma e sarcoma do endométrio. As doentes tratadas com TAM têm também maior incidência de leiomiomas, adenomiose e endometriose, assim como maior risco de quistos do ovário. O método de primeira linha na vigilância das mulheres sob TAM é a ecografia transvaginal (US-TV). O endométrio apresenta-se frequentemente espessado e com áreas quísticas, aspectos passíveis de melhor caracterização por histerossonografia e ressonância magnética. Nas imagens ponderadas em T2, um endométrio espessado e heterogéneo com captação de aspecto reticulado e a opacificação da interface endométrio-miométrio associam-se a lesões de pior prognóstico (pólipos, hiperplasia atípica e neoplasia). O conhecimento dos efeitos ginecológicos do TAM e da sua tradução radiológica promove o diagnóstico precoce e adequado encaminhamento destas doentes.

Activity of the Ovarian Germinal Epithelium in the Freshwater Catfish, Pimelodus maculatus (Teleostei: Ostariophysi: Siluriformes): Germline Cysts, Follicle Formation and Oocyte Development

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

Ovarian mucinous cystadenoma in a gray brocket deer (Mazama gouazoupira)

An ovarian mucinous cystadenoma is described in a gray brocket deer (Mazama gouazoupira). The tumor was histologically characterized by the presence of cysts and proliferation of papillae, both lined by single- or multi-layered pleomorphic epithelial cells that contained alcian blue-positive mucins.

Germ line Cysts and the Formation of the Germinal Epithelium During the Female Gonadal Morphogenesis in Cyprinus Carpio (Teleostei: Ostariophysi: Cypriniformes)

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

Hormonal treatment of dairy goats affected by hydrometra associated or not with ovarian follicular cyst

Hydrometra is considered a very important pathological condition, because it represents one of the main causes of temporary infertility in dairy goats. The objective was (i) to evaluate a protocol for the treatment of hydrometra associated (n=2) or not (n=17) with follicular ovarian cyst in 19 dairy goats and (ii) to assess its reproductive efficiency after treatment. For this purpose, 10. mg of dinoprost (PGF) divided in two equal doses were administered to all animals intravulvosubmucosally on Days 0 and 10. In addition, 500. IU hCG were administered on Day 7. Ultrasound exams were performed in all females from Days 0 to 3, 7 and 10 to 13 of treatment, in order to evaluate uterus drainage after each treatment. Goats were monitored for estrus after both treatments and mated after the second dose of PGF. Blood samples were collected from 11 goats to determine plasma progesterone concentrations before, during and after treatment. Of the 19 goats treated, 16 lost weight after the first dose, probably due to uterine discharge. Complete drainage of uterine fluid was observed in 11/19 (57.9%) and 17/19 (89.5%) after the first and second doses, respectively. Afterwards, we diagnosed 2 more goats with follicular cysts, for a total of 21.1% (4/19) of animals exhibiting hydrometra and ovarian cyst concomitantly. In one doe the diagnosis was on Day 2 and in the other on Day 11. All does showed progesterone concentrations superior to 1. ng/mL at Day 0, with an average of 10.6 ± 1.4. ng/mL. Out of the 10 goats mated, only two became pregnant after treatment, corresponding to 10.5% of the total (2/19). Although prostaglandin was effective to drain the uterine fluid and led to the onset of estrus, it did not improve the pregnancy rate. The use of hCG in female goats was not effective in luteinizing the cysts. It can be concluded that hydrometra alone or associated with ovarian follicular cyst may adversely affect goat reproductive performance. © 2012 Elsevier B.V.