Citologia Hormonal do Trato Urinário Baixo e da Vagina de Mulheres na Pós-menopausa, antes e durante Estrogenioterapia Oral e Transdérmica

Objetivo: avaliar a ação dos estrogênios por via oral ou transdérmica nas células do trato urinário baixo e da vagina, em mulheres menopausadas. Métodos: foram incluídas 25 mulheres na pós-menopausa, nas quais se estudaram os efeitos citológicos da terapia de reposição hormonal estrogênica, por via oral e por via transdérmica, sobre as células da vagina e do sedimento urinário. As pacientes foram distribuídas aleatoriamente em 2 grupos: Grupo I, constituído por 14 mulheres que receberam 0,625 mg de estrogênio conjugado eqüino associado a 5 mg de acetato de medroxiprogesterona, por via oral, diariamente sem intervalo por três meses, e Grupo II, formado por 11 mulheres que fizeram uso de 17-beta-estradiol matricial na dose de 50 mig, por via transdérmica, semanalmente, associado a 5 mg de acetato de medroxiprogesterona diariamente por três meses. As amostras urinárias foram obtidas do jato inicial da primeira urina da manhã, após asseio dos genitais, em frascos estéreis fornecidos pelo laboratório. A urina foi centrifugada e o esfregaço realizado a partir do sedimento urinário. Os esfregaços da vagina e do sedimento urinário foram imediatamente fixados em álcool absoluto e corados pelo método de Shorr. Resultados: observou-se que nas pacientes que utilizaram a via oral, houve maturação das células da vagina (o índice se elevou de 45,4 a 65,5 com dois meses de tratamento, permanecendo praticamente constante (62,0) a seguir. Quanto às células urinárias, não houve variação do valor de maturação (56,4 antes da medicação e 60,4 no final do período). Ao examinarmos tanto as células da urina quanto da vagina de pacientes que utilizaram a via transdérmica, notou-se que houve resposta satisfatória. Conclusão: com estes resultados podemos sugerir que os estrogênios, quando administrados por via transdérmica, estão associados à resposta satisfatória quanto ao trofismo tanto na vagina quanto na uretra. No entanto, quando se utiliza a via oral, nem sempre este resultado pode ser observado.

Caracterização de leveduras isoladas da vagina e sua associação com candidíase vulvovaginal em duas cidades do sul do Brasil

OBJETIVOS: avaliar a distribuição de espécies de leveduras isoladas da vagina em duas localidades do sul do Brasil e comparar o perfil de suscetibilidade in vitro destas leveduras a antifúngicos usados na prática clínica. MÉTODOS: todas as mulheres atendidas entre janeiro e junho de 2004 para exames rotineiros de amostras vaginais, independente de serem sintomáticas ou não, foram incluídas neste estudo. Foram excluídas as que apresentavam imunodeficiências como AIDS ou outras infecções genitais. Amostras de conteúdo vaginal dessas mulheres (Jaraguá do Sul - SC (n=130) e Maringá - PR (n=97)) foram cultivadas. As leveduras isoladas foram identificadas e submetidas ao teste de suscetibilidade aos antifúngicos fluconazol, nistatina e anfotericina B. RESULTADOS: a freqüência de cultura positiva para levedura foi semelhante nas duas localidades, aproximadamente 24%. Candida albicans foi a espécie prevalente, mas sua freqüência diferiu: em SC correspondeu a 77,4% das leveduras e foi a mais freqüente tanto nas mulheres sintomáticas quanto nas assintomáticas. Já no PR foi 50,0%, com predomínio mais evidente nos casos sintomáticos. Observamos altos índices de suscetibilidade ao fluconazol e anfotericina B, porém 51,1% das leveduras apresentaram suscetibilidade dependente da dose (S-DD) para nistatina. C. albicans mostrou maior tendência de resistência à nistatina (52,8% de S-DD) do que as espécies não-albicans (44,4%). CONCLUSÕES: nossos dados mostram diferenças regionais quanto à espécie de levedura em amostras vaginais. Sugerem que a determinação da espécie pode ter implicação clínica, considerando as diferenças quanto à suscetibilidade, principalmente à nistatina, e que poderiam ter importância no manejo da candidíase vulvovaginal.

Aggressive angiomyxoma of the vagina: a case report

Aggressive angiomyxoma is a rare, slow-growing soft tissue tumor that usually arises in the pelvis and perineal regions of women in reproductive age, with a marked tendency to local recurrence. Because of its rarity, it is often initially misdiagnosed. Surgical resection is the main treatment modality of aggressive angiomyxoma. We describe a case of a vaginal aggressive angiomyxoma in a 47-year-old woman in which the diagnosis was only made after histological examination. The etiology, presentation, diagnosis and management of this rare tumor are outlined. Angiomyxoma of vulva and vagina refers to a rare disease. Pre-operative diagnosis is difficult due to rarity and absence of diagnostic features, but it should be considered in every mass in genital, perianal and pelvic region in a woman in the reproductive age. Thus, these cases should have complete radiological workup before excision, as pre-diagnosis can change the treatment modality and patient prognosis'.

Ultrastructural study of the neovagina following the utilization of human amniotic membrane for treatment of congenital absence of the vagina

We present an ultrastructural study of the utilization of human amniotic membrane in the treatment of congenital absence of the vagina in 10 patients. All patients were surgically treated with application of an amniotic membrane graft using the modified McIndoe and Bannister technique. Sixty days after surgery, samples of the vaginal neo-epithelium were collected for transmission electron microscopy analysis. The ultrastructural findings consisted of a lining of mature squamous epithelium indicating the occurrence of metaplasia of the amniotic epithelium into the vaginal epithelium. The cells were arranged in layers as in the normal vaginal epithelium, i.e., superficial, intermediate and deep layers. There were desmosomes and cytoplasmic intermediate cytokeratin filaments, as well as some remnant features of the previous amniotic epithelium. These findings suggest that human amniotic membrane is able to complete metaplasia into squamous cells but the mechanism of this cellular transformation is unknown

Valta, väkivalta ja vagina : seksuaalinen vallankäyttö tieteen ja taiteen silmin

Kirjallisuusarvostelu

Use of conventional PCR and smear microscopy to diagnose pulmonary tuberculosis in the Amazonian rainforest area

The diagnostic usefulness of Ziehl-Neelsen (ZN)-stained sputum smears combined with conventional polymerase chain reaction (ZN/PCR) to amplify IS6110 region DNA extracted from ZN slides was evaluated. The objective was to verify if this association could improve tuberculosis (TB) diagnosis in patients at remote sites. The study was carried out in 89 patients with culture-confirmed pulmonary TB as defined by the Brazilian Manual for TB Treatment. The participants were recruited in a reference unit for TB treatment in Rondônia, a state in the Amazonian area in northern Brazil. ZN, PCR, and culture performed in the sputum samples from these patients were analyzed in different combinations (i.e., ZN plus PCR and ZN plus culture). The prevalence rates of pulmonary TB in these patients were 32.6 and 28.1% considering culture and ZN/PCR, respectively. The sensitivity and specificity of ZN/PCR were 86 and 93%, respectively. ZN/PCR was able to detect more TB cases than ZN alone. This method could offer a new approach for accurate tuberculosis diagnosis, especially in remote regions of the world where culture is not available.

Actinomyces coleocanis sp. nov., from the vagina of a dog

A hitherto undescribed Actinomyces-like bacterium was isolated from the vagina of a dog. Biochemical testing and PAGE analysis of whole-cell proteins indicated that the isolate was phenotypically different from previously described Actinomyces species and related taxa. Sequencing of 165 rRNA showed that the unknown bacterium was distinct from all currently known Actinomyces species. Phylogenetically, the unidentified organism displayed a specific association with Actinomyces europaeus, but a sequence divergence of > 5% demonstrated that it represents a distinct species. Based on both phenotypic and 165 rRNA sequence considerations, it is proposed that the unknown strain from a dog be classified as a novel species, Actinomyces coleocanis sp. nov. The type strain is CCUG 41708T (= CIP 106873T).

Arcanobacterium hippocoleae sp. nov., from the vagina of a horse

A polyphasic taxonomic study was performed on a previously unidentified gram-positive, facultatively anaerobic, diphtheroid-shaped organism isolated from a vaginal discharge of a horse. Comparative 16S rRNA gene sequencing demonstrated that the strain was a member of the genus Arcanobacterium, but sequence divergence values of >4% with described species of this genus (viz: Arcanobacterium haemolyticum, Arcanobacterium bernardiae, Arcanobacterium phocae, Arcanobacterium pluranimalium and Arcanobacterium pyogenes) demonstrated that the isolate represented a novel species. The unknown bacterium was readily distinguished from other Arcanobacterium species by biochemical tests. Based on phylogenetic and phenotypic evidence, it is proposed that the unknown bacterium be classified as Arcanobacterium hippocoleae sp. nov. The type strain of A. hippocoleae is CCUG 44697T (= CIP 106850T).

Scanning Electron Microscopic Preliminary Study of the Efficacy of SmearClear and EDTA for Smear Layer Removal after Root Canal Instrumentation in Permanent Teeth

This study aimed to evaluate the efficacy of SmearClear (SybronEndo, Orange, CA) and EDTA for smear layer removal from root canals of permanent teeth after instrumentation. Thirty extracted human permanent teeth (n = 10) were randomly assigned to the following groups: group 1 = 14.3% EDTA, group 2 = SmearClear, and group 3 = no smear layer removal procedure was undertaken (control). The specimens were submitted to scanning electron microscopy analysis. Magnifications of 200x and 750x were used to evaluate cleaning at the apical, middle, and cervical thirds according to a three-point scoring system. Data were analyzed statistically by the Mann-Whitney U test (5% significance level). Groups 1 and 2 differed significantly from group 3 (p < 0.01). However, there was no statistically significant difference (p > 0.05) between groups 1 and 2. In conclusion, SmearClear was able to remove the smear layer from the root canals of permanent teeth similarly as 14.3% EDTA, suggesting that both solutions may be indicated for such purpose. (J Endod 2008,34:1541-1544)

Histologia e morfometria das glândulas das junções infundíbulo-magno e útero-vagina de codorna doméstica

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

Comparative analysis of root surface smear layer removal by different etching modalities or erbium:yttrium-aluminum-garnet laser irradiation. A scanning electron microscopy study

The purpose of this study was to evaluate the effect of erbium:yttrium-aluminum-garnet (Er:YAG) laser (2.94 mu m) irradiation on the removal of root surface smear layer of extracted human teeth and to compare its efficacy with that of citric acid, ethylenediamine tetra-acetic acid (EDTA), or a gel containing a mixture of tetracycline hydrochloride (HCl) and citric acid, using scanning electron microscopy (SEM). Thirty human dentin specimens were randomly divided into six groups: G1 (control group), irrigated with 10 ml of physiologic saline solution; G2, conditioned with 24% citric acid gel; G3, conditioned with 24% EDTA gel; G4, conditioned with a 50% citric acid and tetracycline gel; G5, irradiated with Er:YAG laser (47 mJ/10 Hz/5.8 J/cm(2)/pulse); G6, irradiated with Er:YAG laser (83 mJ/10 Hz/10.3 J/cm(2)/pulse). Electron micrographs were obtained and analyzed according to a rating system. Statistical analysis was conducted with Kruskal-Wallis and Mann-Whitney tests (P < 0.05). G1 was statistically different from all the other groups; no statistically significant differences were observed between the Er:YAG laser groups and those undergoing the other treatment modalities. When the two Er:YAG laser groups were compared, the fluency of G6 was statistically more effective in smear layer removal than the one used in G5 (Mann-Whitney test, P < 0.01). Root surfaces irradiated by Er:YAG laser had more irregular contours than those treated by chemical agents. It can be concluded that all treatment modalities were effective in smear layer removal. The results of our study suggest that the Er:YAG laser can be safely used to condition diseased root surfaces effectively. Furthermore, the effect of Er:YAG laser irradiation on root surfaces should be evaluated in vivo so that its potential to enhance the healing of periodontal tissues can be assessed.

Evaluation of the Smear Layer and Hybrid Layer in Noncarious and Carious Dentin Prepared by Air Abrasion System and Diamond Tips

Purpose: To analyze the smear layer and the hybrid layer in noncarious and carious dentin prepared by different cutting instruments and restored with composite resin. Study design: Cavities were randomly prepared in 160 specimens (noncarious and artificial carious dentin) by high-speed diamond tips (KG Sorensen 1013), air abrasion system (Prepstart, Danville Engineering), ultrasonic tip (CVDentus 8.3231-1), and ultrasonic tip associated with ultrasonic cavitation by water for 10 s. Half of the cavities in each group were conditioned with 37% phosphoric acid for 15 s. The amount of smear layer and dentinal tubules present were analyzed using scanning electron microscopy and graded from 0 to 3. Cavities were prepared in another 20 noncarious specimens and 20 carious specimens and restored with adhesive composite resin system. The restorations were hemisected longitudinally and analyzed using scanning electron microscopy to evaluate the hybrid layer and resinous prolongation characteristics, using scores ranging from 1 to 6. Results: The data were statistically analyzed using Kruskal-Wallis and Dunn tests at 5% of significance level. There was evidence that the most efficient smear layer removal was the acid etching in the noncarious dentin and the water ultrasonic cavitation in the carious dentin. The hybrid layer formed on the noncarious and carious dentin prepared by the ultrasonic tip was more regular than in the specimens prepared by high-speed diamond tip, with many resinous prolongations. Conclusion: The ultrasonic tip seems to be a promising tool for carious dentin cavity preparation. Microsc. Res. Tech. 73:597-605, 2010. (C) 2009 Wiley-Liss, Inc.

A comparative SEM study of smear layer removal by detergents and EDTA on the root surface

The present study performed an SEM evaluation of the efficiency of the following detergents on smear layer removal on the root surface: sodium lauryl sulphate, Plax, castor oil, and EDTA 24%. Sodium lauryl sulphate did not remove the smear layer and showed the worst results of all detergents tested. Plax and castor-oil detergents showed similar results represented by partial removal of the smear layer; these results were better than those obtained in the control (physiologic serum) and sodium lauryl sulphate groups. Neutral EDTA 24% was the most efficient detergent for smear layer removal.