Thiele massage as a therapeutic option for women with chronic pelvic pain caused by tenderness of pelvic floor muscles

Aims and objectives Musculoskeletal system has been found to be involved in genesis and perpetuation of chronic pelvic pain (CPP) and has strong evidences that up to 80% of women with CPP present dysfunction of the musculoskeletal system. In this study, we report a series of women with CPP caused by tenderness of pelvic floor muscles successfully treated with Thiele massage. Methods Were included in this study six women with CPP caused by tenderness of the levator ani muscle that underwent transvaginal massage using the Thiele technique, over a period of 5 minutes repeated once a week for 4 weeks. After 1 month, the women returned for follow-up. Results The median tenderness score for the six women evaluated was 3 at the first evaluation and 0 after 1 month of follow-up (P < 0.01). The mean Visual Analogue Scale and McGill Pain Index scores were 8.1 and 34, respectively, at the first evaluation, and 1.5 and 16.6 at follow-up (P < 0.01). Conclusion Thiele massage appears to be very helpful for women with CPP caused by tenderness of the levator ani muscle. However, these results are preliminary and a larger number of women are necessary to obtain more conclusive results.

Increased cell proliferation in experimentally induced endometriosis in rabbits

Objective: To characterize the pattern of cell proliferation and apoptosis of eutopic and ectopic endometrium in rabbits after endometrium implantation for the experimental induction of endometriosis. Design: Animal experimental study. Setting: Sector of experimental surgery. Animal(s): Twenty-female New Zealand rabbits. Intervention(s): All animals underwent laparotomy for endometriosis induction by resection of one uterine horn, isolation of the endometrium, and fixation of tissue segment to the pelvic peritoneum. Two groups of 10 animals were sacrificed 4 and 8 weeks after endometriosis induction. The lesion was excised together with the opposite uterine horn for endometrial gland and stroma determination. Main Outcome Measure(s): Cell proliferation and apoptosis were determined in the eutopic and ectopic endometrium, and the cell proliferation index (CPI) and apoptotic index (AI) were calculated as the number of labeled cells per 1,000 cells. The tissue homeostasis index was the CPI/AI ratio. Glands and stroma were analyzed separately. Result(s): The CPI for ectopic tissue was increased compared with eutopic tissue, but there was no difference in the ectopic lesions between 4 and 8 weeks of induction. Considering only the AI, eutopic and ectopic endometrium did not differ after 4 weeks, but differed significantly in glandular tissue after 8 weeks. The tissue homeostasis index revealed cell proliferation in these tissues, with a CPI/AI more than 1. Conclusion(s): Ectopic lesions seem to have a higher CPI than eutopic endometrium, with uncontrolled tissue growth occurring in induced endometriotic lesions. (Fertil Steril (R) 2010;93:1637-42. (C)2010 by American Society for Reproductive Medicine.)

Importance of Pelvic Muscle Tenderness Evaluation in Women with Chronic Pelvic Pain

Objective. To determine the prevalence of pelvic muscle tenderness in women with chronic pelvic pain (CPP) and to assess the importance of evaluating muscle tenderness in such women. Design. Observational study of 48 healthy female volunteers and 108 women with CPP, who were clinically evaluated for pelvic muscle tenderness by two researchers blinded to all clinical data. Results. The frequency of clinically detected pelvic muscle tenderness was significantly higher in women with CPP than in healthy volunteers (58.3% vs 4.2%, P < 0.001). Among women with CPP, those with pelvic muscle tenderness had higher Beck Depression Index scores (22 [6-42] vs 13 [3-39], P = 0.02) and higher rates of dyspareunia (63.5% [40/63] vs 28.9% [13/45], P < 0.004) and constipation (46.0% [29/63] vs 26.7% [12/45], P = 0.05) than those without pelvic muscle tenderness. Conclusion. Tenderness of pelvic muscles was highly prevalent among women with CPP and was associated with higher BDI scores and higher rates of dyspareunia and constipation. Determination of pelvic muscle tenderness may help in identifying women who require more intense treatment for CPP.

Increased Capsaicin Receptor TRPV1 in the Peritoneum of Women With Chronic Pelvic Pain

Objective: To investigate the expression of capsaicin receptor [transient receptor potential vanilloid type-1 (TRPV1)] in the peritoneum of women with chronic pelvic pain (CPP). Methods: A case-control study was conducted on 25 women with CPP and 10 controls. Samples of the rectouterine excavation (2 cm 2) were obtained by laparoscopy, fixed in 4% formaldehyde, and underwent immunohistochemistry analysis using rabbit anti-TRPV1 (1:400) polyclonal antibodies and anti-protein gene product 9.5 (PGP 9.5) (1:2000) as a neuronal marker. Ten sequential images of high magnification fields ( x 40) were captured from each slide and the area identified with the antibody was calculated with Kontron V2.0 software. Results: Immunoreactivity to TRPV1 was sparsely detected in the nervous tissue and epithelium of endometriotic lesions. The percent area of immunoreactivity for TRPV1 [expressed as median (range)] was greater in specimens from women with CPP, 1.02% (0.54 to 2.93), than from women without the disease, 0.14% (0.07 to 1.12) (P<0.0001). This greater expression was not secondary to an increase in neuronal fibers because there was also a significant difference in the percent area TRPV1:PGP 9.5 ratio between women with CPP, 1.18 (0.26 to 4.63), and controls, 0.15 (0.06 to 0.95) (P = 0.0003). Discussion: TRPV1 may play an important role in the maintenance and perpetuation of symptoms in women with CPP. In view of the immunoreactivity detected for TRPV1, the endometriotic lesion may have the ability to interfere with nociception or with the inflammatory peritoneal environment in women with CPP. Further Studies are needed to elucidate the participation of TRPV1 in CPP and its association with endometriosis.

TRPV1 Expression on Peritoneal Endometriosis Foci is Associated With Chronic Pelvic Pain

Objective: To investigate the expression of capsaicin receptor (transient receptor potential vanilloid type 1 [TRPV1]) in the peritoneal endometriosis foci of women with and without chronic pelvic pain (CPP). Methods: A case-control study was conducted on 49 women with endometriosis who underwent laparoscopy, 28 of whom had CPP and 21 without CPP. Samples from peritoneum of the rectouterine excavation (2 cm(2)) were obtained by laparoscopy, fixed in 4% formaldehyde, and underwent immunohistochemistry analysis using rabbit anti-TRPV1 (1:400) polyclonal antibody. Results: Image analysis revealed that the immunoreactivity for TRPV1 was more frequent in specimens (endometriosis foci) from women with CPP (n = 15 of 28, 53.6%), compared to samples from the endometriosis foci of women without CPP (n = 6 of 21, 28.6%; P = .04). There was no correlation with duration, intensity of pain, or stage of the disease (endometriosis). Discussion: The present study shows that TRPV1 expression in peritoneal endometriosis foci is related to CPP in women. However, this association is not related to the endometriosis stage. In view of the immunoreactivity for TRPV1 observed here, we believe that some endometriotic lesions may provide a scenario for TRPV1 to be tonically active and this activity may contribute to the underlying pathology of CPP.

Treatment for low-risk gestational trophoblastic disease: Comparison of single-agent methotrexate, dactinomycin and combination regimens

Objectives. To compare the efficacy of three different standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the FIGO staging system in a single-institute setting. Methods. From 1980 until 2002, we retrospectively reviewed 108 cases with low-risk persistent gestational trophoblastic disease who were treated with first-line chemotherapy. Patients were divided in three groups according to chemotherapy regimen: patients treated with methotrexate (MTX group; n=42), patients treated with dactinomycin (ACT group; n=42) and patients treated with methotrexate and dactinomycin in combination (MACT group; n=24). We compared the number of chemotherapy courses for achieving remission, the duration of treatment, the adverse side effects, the efficacy of the treatment and the need for performing a hysterectomy among the groups Results. The complete remission rates were 69%, 61.4% and 79.1% for methotrexate (MTX), dactinomycin (ACT) and the combination regimen (MACT) treated groups, respectively (p=0.7). The duration of the treatment and the number of chemotherapy courses were similar among the groups (p = 0.2 and p = 0.4, respectively). Adverse side effects rate was reported to be 62.5% in the MACT group, 28.6% in the MTX group and 19.1% in the ACT group (p=0.0003). Second-line chemotherapy was indicated for 30 patients. Hysterectomy was performed in 21 patients overall, and there was no difference among the groups (P=0.6). Conclusion. Our analysis indicates that single-agent chemotherapy regimens are as effective as combination chemotherapy for low-risk gestational trophoblastic disease. Dactinomycin is a less toxic drug and might offer the best cost-effective treatment option. Methotrexate must be considered as the regimen of choice for low resource areas because of the feasibility of its administration. (c) 2007 Elsevier Inc. All rights reserved.

Complicações perinatais no Hospital Universitário Cassiano Antonio de Moraes: uma questão de idade?

A população brasileira vem passando por uma transição demográfica e epidemiológica, caracterizadas por aumento na expectativa de vida, diminuições nas taxas de mortalidade, natalidade e fecundidade, aumento da escolaridade, diminuição do desemprego, aumento das enfermidades crônico-degenerativas e diminuição das enfermidades infectocontagiosas. Tais transições vêm afetando também a perinatologia, com aumento proporcional e absoluto das gestações tardias tanto no Espírito Santo quanto no Brasil. Este estudo realizou uma análise retrospectiva das gestações tardias no HUCAM, comparando as mesmas com as gestações de mulheres adolescentes e adultas jovens quanto aos seguintes desfechos perinatais: anomalia fetal, hipóxia no primeiro e quinto minuto de vida, duração da gestação, peso ao nascer e tipo de parto. As variáveis foram analisadas categoricamente, e comparadas através de análise bivariada, utilizando-se o Teste Exato de Fisher, e através de regressão logística. Na análise bivariada, foi encontrada apenas associação entre a idade materna e o tipo de parto, mas esta associação não foi confirmada na regressão logística. Analisando outros fatores relativos à gestação, restou evidenciado uma associação positiva entre um menor número de consultas pré-natais e uma maior frequência de hipóxia no recém-nascido e de prematuridade (odds ratio de 2,9 e 5,7, respectivamente). Ao final deste trabalho são elaboradas propostas para aprimoramento da coleta e do armazenamento de dados acerca da gestação no HUCAM, e para otimização da assistência pré-natal das gestantes atendidas pelo hospital, visando melhorar os desfechos perinatais encontrados.

Prevalência de Chlamydia trachomatis em casos de partos pretermo atendidos no Hospital Universitário Cassiano Antonio Moraes, Vitória - ES

Introdução: O parto pretermo (PPT) é um dos principais determinantes da morbimortalidade neonatal, acarretando consequências adversas para saúde. As causas são multifatoriais, sendo a infecção intrauterina a razão mais provável para explicar a maioria destes desfechos. Acredita-se que a infecção por Chlamydia trachomatis (CT) também esteja envolvida no PPT e rotura prematura de membranas (ROPREMA). Objetivo: Determinar a prevalência de CT em parturientes e os possíveis fatores de risco relacionados com os casos de partos prematuros atendidos no Hospital Universitário Cassiano Antonio Moraes. Métodos: Estudo de corte transversal, realizado entre parturientes que apresentaram PPT em um Hospital Universitário em Vitória - ES, entre junho de 2012 e agosto de 2013. As participantes responderam a um questionário contendo dados sóciodemográficos, comportamentais e clínicos. Foi coletada uma amostra de urina para rastreio de CT usando reação em cadeia da polimerase. Resultados: A prevalência de PPT durante o período do estudo foi de 26%. Um total de 378 casos de PPT foram registrados, entre eles 323 mulheres foram testadas para o CT; quarenta e cinco (13,9%) tiveram um resultado positivo, sendo que 31,6% possuiam até 24 anos e as mulheres infectadas pela CT eram mais jovens do que as demais (p = 0,022). Um total de 76,2% eram casadas/em união estável, e CT foi mais frequente entre as solteiras (p = 0,018); 16,7% relataram primeira relação sexual com menos de 14 anos de idade. As causas de PPT foram materno-fetais em 40,9%, ROPREMA em 29,7% e trabalho de parto prematuro em 29,4%. Na análise multivariada, ser casada foi um fator de proteção [OR = 12:48 (IC 95%: 0,24-0,97)]. Nenhuma das demais características foram associadas com a infecção por CT. Conclusões: Este estudo evidencia uma alta prevalência de infecção por CT entre parturientes com PPT. Essa alta prevalência reforça a necessidade da definição de estratégias de rastreamento e assistência durante o pré-natal.

Corte, poder e utopia: O Relox de Príncipes (1529) de Fr. Antonio de Guevara e a sua fortuna na Europa do século XVI

Em Valladolid era publicado, em 1529, o Libro llamado Relox de Príncipes, da autoria de fr. Antonio de Guevara, iniciando-se “[...] la más fantástica carrera y reputación literaria del siglo XVI, tanto dentro como fuera de España [...]” (Márquez Villanueva e Redondo 173). A história do Relox de Príncipes encontra-se intimamente ligada à edição, cerca de um ano antes, em Sevilha, nos prelos de Jacobo Cromberger, sem nome de autor, do Libro Áureo de Marco Aurelio, também da autoria de Guevara. Com efeito, a parte mais importante desta obra impressa em 1528 viria a integrar a publicação “oficial” de 1529, facto que originaria uma persistente confusão entre ambas, até porque aquela que pode considerar-se a versão primitiva, o Libro Áureo, apesar do aparente repúdio do autor, continuaria a ser objecto de sucessivas edições autónomas. Isso mesmo dizia expressamente Antonio de Guevara no prólogo do Relox de Príncipes, sustentando que a impressão do Marco Aurelio fora feita sem seu consentimento. Após referir que, a pedido do imperador, que se encontrava doente na altura, lhe oferecera o manuscrito, incompleto, do Libro Áureo, Guevara afirmava a sua mágoa por, sem poder controlar esse processo, o manuscrito ter sido copiado e recopiado na corte pelas mais diversas mãos, e progressivamente adulterado, publicando-se uma versão na qual ele próprio não se reconhecia.

Entrevista com Antonio Bonet Correa

Fundação para a Ciência e a Tecnologia (FCT), Fundação Millennium bcp, Imprensa Nacional-Casa da Moeda

A influência do evento El Niño - Oscilação Sul e Atlântico Equatorial na precipitação sobre as regiões norte e nordeste da América do Sul

Os impactos de eventos anômalos no oceano Pacífico associados ao El Niño-Oscilação Sul (ENOS) na precipitação da região norte e nordeste da América do Sul foram avaliados para o período de 1900 a 2007, fazendo-se uso de análise de composições. Os eventos El Niño (La Niña) no Pacífico que juntamente com um Modo Equatorial no Atlântico (MEA) frio (quente) formam um gradiente interbacias entre o Pacífico e Atlântico foram analisados considerando, separadamente, aqueles para os quais o gradiente se forma na fase inicial do ENOS daqueles em que o gradiente se forma na fase de decaimento do ENOS. Os resultados mostram que o padrão de precipitação na região norte e nordeste da América do Sul é reforçado mediante a configuração do gradiente interbacias durante a fase inicial do ENOS. Nesse caso, uma possível explicação é que o MEA de sinal contrário ao ENOS durante sua fase inicial cria condições favoráveis para o desenvolvimento de um gradiente inter-hemisférico no Atlântico Tropical atuando no mesmo sentido do gradiente interbacias, e colaborando para fortalecer o efeito do El Niño (La Niña) na precipitação. Por outro lado, para os eventos ENOS em que o gradiente se forma em sua fase de decaimento, o impacto na precipitação é mais significativo na região norte e centro-oeste da bacia. Uma possível explicação para essas diferenças está associada às mudanças que ocorrem na circulação atmosférica leste-oeste associada ao gradiente leste-oeste de anomalias da TSM. Os resultados deste estudo podem ser úteis, principalmente, para fins de monitoramento climático.

Tentamen florae Abyssinicae :seu, Enumeratio plantarum hucusque in plerisque Abyssiniae provinciis detectarum et praecipue a beatis doctoribus Richard Quartin Dillon et Antonio Petit (annis 1838-1843) lectarum /auctore Achille Richard.

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