Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding

Objective: To describe the prevalence of hysteroscopic findings and histologic diagnoses inpatients with abnormal uterine bleeding (AUB).Design: Retrospective series of consecutive patients.Setting: Tertiary care University hospital and private office.Patient(s): Four thousand fifty-four hysteroscopies with biopsy in patients with AUB evaluated between June 1993 and December 2004.Intervention(S): Hysteroscopies were performed using 2.9-mm or 4-mm telescopes with CO2 or saline as the distension media. Biopsies were (lone with a 5-mm grasper or with a Novak's curette.Main Outcome Measure(s): Prevalence of hysteroscopic findings and histologic analysis of biopsies.Result(S): Endometrial polyp was the most frequent hysteroscopic finding, accounting for 1,374 (33.9%) cases. Normal uterine cavity and cervical canal were found in 814 (20.1%) patients. Submucous fibroids were diagnosed in 302 (7.5%) women. Normal endometrium was the most frequent histologic diagnosis, accounting for 1,888 (46.6%) cases. Endometrial polyp was found in 1, 115 (27.5%) patients. Endometrial hyperplasia was diagnosed in 613 (15.1%) and endometrial cancer in 105 (2.6%) women.Conclusion(s): Endometrial polyps are the most frequent hysteroscopic findings in patients with AUB, whereas normal endometrium is the most frequent histologic diagnosis.

Características das Curvas de Regressão da Gonadotrofina Coriônica Pós-mola Hidatiforme Completa

Objetivos: construir a curva de regressão do b-hCG pós-mola hidatiforme completa (MHC) com remissão espontânea e comparar com a curva de regressão pós-MHC com tumor trofoblástico gestacional (TTG). Análise comparativa da curva de regressão do b-hCG das portadoras de MHC, acompanhadas no Serviço, com a curva de regressão observada por outros autores1-3. Métodos: foi realizada avaliação clínica e laboratorial (dosagem sérica de b-hCG), na admissão e no segmento pós-molar, de todas as pacientes com MHC, atendidas entre 1990 e 1998 no Hospital das Clínicas de Botucatu - Unesp. O resultado da determinação seriada do b-hCG foi analisado em curvas log de regressão. A evolução da curva de regressão do b-hCG foi analisada e comparada em MHC com remissão espontânea e MHC com TTG numa curva log de regressão, com intervalo de confiança de 95%. A curva log de regressão do grupo de remissão espontânea foi comparada com curvas consideradas padrão1,2. Foram construídas curvas log individuais de todas as pacientes e classificadas de acordo com os quatro tipos de curva (I, II, III e IV), propostos para o seguimento pós-molar³. Resultados: 61 pacientes com MHC tiveram seguimento pós-molar completo, 50 (82%) apresentaram remissão espontânea e 11 (18%) desenvolveram TTG. No grupo de pacientes com MHC e remissão espontânea, o tempo para alcançar a normalização dos níveis do b-hCG, após o esvaziamento molar, foi até 20 semanas. As pacientes que desenvolveram TTG apresentaram desvio precoce da curva de regressão normal do b-hCG, 4 a 6 semanas após o esvaziamento molar. Nestas pacientes, a quimioterapia foi introduzida em média na 9ª semana pós-esvaziamento molar. Conclusões: a curva de regressão do b-hCG pós-MHC com remissão espontânea apresentou declínio log exponencial, semelhante ao observado por outros autores1,2, e diferente das MHC com TTG. Foram identificados três tipos de curvas de regressão do b-hCG, semelhantes aos de Goldstein³, I, II e IV, e outros dois tipos diferentes de regressão do b-hCG: V (regressão normal) e VI (regressão anormal).

Abnormal cell-cycle expression of the proteins p27, mdm2 and cathepsin B in oral squamous-cell carcinoma infected with human papillomavirus

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Tissue evidence of the testosterone role on the abnormal growth and aging effects reversion in the gerbil (Meriones unguiculatus) prostate

Prostate differentiation during embryogenesis and its further homeostatic state maintenance during adult life depend on androgens. Abundant biological data suggest that androgens play an important role in the development of the prostate cancer and other prostatic diseases. The objective of this work was to evaluate the effects of the testosterone supplementation in gerbil (a new experimental model) at different ages. Tissues from experimental animals were studied by histological and histochemistry procedures, androgen receptor immunohistochemistry assay, morphometric-stereological analysis, and transmission electron microscopy (TEM). After the treatment were observed increase of prostate weight and epithelium height in all ages studied. In some adult and aged treated animals, hyperplasic and displasic process were observed, including prostatic intraepithelial neoplasias and adenocarcinomas. Increase of the thickness of the smooth muscle cell (SMC) layer was observed in pubescent and adult animals and TEM revealed apparent SMC hypertrophy. An apparent increase in the frequency of blood vessels distributed by the subepithelial stroma in the treated animals was noticed. Reversion of the natural effects of aging on the prostate was observed in the aged treated animals in some acini of the gland. These data demonstrate that the gerbil prostate is susceptible to androgenic action at the studied ages and it can serve, for example, as experimental model to studies of prostate neoplasic process induction and hormonal therapy in aged animals.

Abnormal expression of bcl-2 and bax in rat tongue mucosa during the development of squamous cell carcinoma induced by 4-nitroquinoline 1-oxide

4-Nitroquinoline 1-oxide (4NQO)-induced rat tongue carcinogenesis is a useful model for studying oral squamous cell carcinoma. The aim of this study was to investigate the expression of bcl-2 and bax during tongue carcinogenesis induced by 4NQO. Male Wistar rats were distributed into three groups of 10 animals each and treated with 50 ppm 4NQO solution through their drinking water for 4, 12 or 20 weeks. Ten animals were used as negative control. Although no histological changes were induced in the epithelium after 4 weeks of carcinogen exposure, bcl-2 and bax were over-expressed (P < 0.01) in all layers of the 'normal' epithelium. The expression levels were the same in all layers of epithelium for both the antibodies used (bcl-2 or bax). In dysplastic lesions at 12 weeks following carcinogen administration, the levels of bcl-2 and bax expression did not increase when compared to negative control with the immunoreactivity for bcl-2 being restricted to the superficial layer of epithelium. In well-differentiated squamous cell carcinoma induced after 20 weeks of treatment with 4NQO, bcl-2 was expressed in some cells of tumour islands. on the other hand, immunostaining for bax was widely observed at the tumour nests. The labelling index for bcl-2 and bax showed an increase (P < 0.05) after only 4 weeks of 4NQO administration. In conclusion, our results suggest that abnormalities in the apoptosis pathways are associated with the development of persistent clones of mutated-epithelial cells in the oral mucosa. Bcl-2 and bax expression appears to be associated with a risk factor in the progression of oral cancer.

Power flow in distribution networks with earth return

The problems of wave propagation and power flow in the distribution network composed of an overhead wire parallel to the surface of the ground have not been satisfactorily solved. While a complete solution of the actual problem is impossible, as it is explained in the famous Carson's paper (1926), the solution of the problem, where the actual earth is replaced by a plane homogenous semi-infinite solid, is of considerable interest. In this paper, a power flow algorithm in distribution networks with earth return, based on backward-forward technique, is discussed. In this novel use of the technique, the ground is explicitly represented. In addition, an iterative method for determining impedance for modelling ground effect in the extended power flow algorithm is suggested. Results obtained from single-wire and three-wire studies using IEEE test networks are presented and discussed. (C) 2003 Elsevier Ltd. All rights reserved.

Validation of hysteroscopic view in cases of endometrial hyperplasia and cancer in patients with abnormal uterine bleeding

STUDY OBJECTIVE: To validate hysteroscopic view with histology in cases of endometrial hyperplasia and cancer in patients with abnormal uterine bleeding (AUB)DESIGN: Retrospective study.(Canadian Task Force classification II-3).SETTING: University teaching hospitals in Rio de Janeiro and São Paulo, and private office in Rio de Janeiro.PATIENTS: Four thousand and fifty-four patients with AUB in whom hysteroscopic views were complete and the histologic result was conclusive.INTERVENTION: Four thousand and fifty-four office hysteroscopies with complete views and conclusive histologic results. The material for histologic examination was obtained through biopsy of the lesion in an outpatient unit or through the resection of the entire lesion in patients who underwent surgery. Histology was considered the gold standard and compared with the hysteroscopic view.MEASUREMENTS AND MAIN RESULTS: In the histology of the 4054 examinations, 613 (15.2%) were endometrial hyperplasia, and 105 (2.6%) were endometrial cancer. The most frequent hysteroscopic finding was endometrial polyps (31.2%). In endometrial hyperplasia, the sensitivity of the hysteroscopic view was 56.3% (95% CI 52.21-60.2%), specificity was 89.1% (95% CI 88.0%-90.1%), positive predictive value (PPV) was 48.0% (95% CI 44.3%-51.7%), negative predictive value (NPV) was 92.0% (95% Cl 90.1%-92.9%), and accuracy was 72.7% (95% CI 70.7%-74.7%). Accuracy was defined as the proportion of correct results among the hysteroscopic examinations. In endometrial cancer, the sensitivity of the hysteroscopic view was 80.0% (95% Cl 71.1%-87.2%), specificity was 99.5% (95% CI 99.2%-99.7%), PPV was 81.5% (95% Cl 72.7%-88.5%), NPV was 99.5% (95% CI 99.2%-99.7%), and accuracy was 89.8% (95% CI, 85.9%-93.6%). In the 814 patients (20.0%) in whom the hysteroscopic view was normal, there were no false negatives for endometrial cancer; however, there were 37 (4.5%) false negatives for endometrial hyperplasia. In the histologic cases of endometrial cancer, 101 (96.2%) hysteroscopic views were compatible with cancer or hyperplasia (80.0% and 16.2%, respectively). Ninety-seven out of 103 hysteroscopic views with cancer findings (94.2%) had histologic diagnosis of cancer or hyperplasia (81.5% and 12.6%, respectively).CONCLUSION: It seems that even in face of good validity of hysteroscopic view for endometrial hyperplasia and cancer, histologic study is mandatory in the presence of any lesion as the hysteroscopic view cannot completely replace the histologic study in patients with AUB. (C) 2006 AAGL. All rights reserved.

HIGH-TEMPERATURE SUPERFLUIDITY WITH ABNORMAL FERMIONIC OCCUPANCY

We examine a Lipkin based two-level pairing model at finite temperature and in the thermodynamic limit. Whereas at T = 0 the model exhibits a superconducting ground state for sufficiently high values of the coupling constant, a partially superconducting phase in which some of the particles are paired, is found to survive at high temperatures in a special treatment. This phase is a mixture of abnormally-occupied eigenstates, which lie at higher energy, of the interactionless model Hamiltonian.

Post-selection and return of foraged material by Acromyrmex subterraneus brunneus (Hymenoptera: Formicidae)

Two colonies of Acromyrmex subterraneus brunneus Forel (Hymenoptera: Formicidae) were studied regarding their behavior during cultivation of the fungus garden to determine a) the existence of post-selection of foraged material by the workers, and b) if present, the mechanism of this discrimination and how this material is returned. Many studies on plant processing by leaf-cutting ants have been carried out, but none of them has investigated the decision-making process of workers in the case of erroneous food selection. For this purpose, material with different degrees of moisture and hardness (floral sponge, polystyrene, plastic and clay) were individually offered to the colonies and the tasks performed by the different size categories were carefully recorded. Three tasks, i.e., foraging, cultivation of the fungus garden and return of the foraged material, were studied and subdivided into 14 subtasks. Analysis of all inert materials as a whole showed the presence of post-selection of foraged material through the return of material inadequate for the workers and the fungus. Discrimination of the inert material was observed at the time of shredding, probably based on parameters such as physical resistance to cutting and moisture content. A. s. brunneus workers showed flexibility in their activities during substrate processing. The observed post-selection of foraged material provides strong evidence for the cognitive abilities of worker ants and of the colony as a whole. Polymorphism and a complex society represent vital characteristics for the ecological success of this species.

Abnormal evening vertical plasma drift and effects on ESF and EIA over Brazil-South Atlantic sector during the 30 October 2003 superstorm

Equatorial F region vertical plasma drifts, spread F and anomaly responses, in the south American longitude sector during the superstorm of 30 October 2003, are analyzed using data from an array of instruments consisting of Digisondes, a VHF radar, GPS TEC and scintillation receivers in Brazil, and a Digisonde and a magnetometer in Jicamarca, Peru. Prompt penetrating eastward electric field of abnormally large intensity drove the F layer plasma up at a velocity ∼1200 ms -1 during post dusk hours in the eastern sector over Brazil. The equatorial anomaly was intensified and expanded poleward while the development of spread F/plasma bubble irregularities and GPS signal scintillations were weaker than their quiet time intensity. Significantly weaker F region response over Jicamarca presented a striking difference in the intensity of prompt penetration electric field between Peru and eastern longitudes of Brazil. The enhanced post dusk sector vertical drift over Brazil is attributed to electro-dynamics effects arising energetic particle precipitation in the South Atlantic Magnetic Anomaly (SAMA). These extraordinary results and their longitudinal differences are presented and discussed in this paper. Copyright 2008 by the American Geophysical Union.