Envejecimiento del sistema urogenital y disfunción sexual femenina / Aging of the urogenital system and female sexual dysfunction

Resumen El sistema genitourinario presenta una serie de cambios micro y macroanatómicos desde el nacimiento, pasando por la pubertad, período reproductivo y por último con la menopausia, en la cual, se desarrolla un conjunto de síntomas sistémicos que incluyen los vasomotores, del sueño, cognitivos, del estado de ánimo y cambios sexuales, asociados a la presencia de disminución de la lubricación, estrechamiento y distensibilidad vaginal, atrofia vaginal, entre otros, que llevan a presentar una clínica de dispareunia, prurito, resequedad, además de síntomas urinarios. Su examinación conlleva la realización de una historia clínica, examen físico y ginecológico. Para confirmar los cambios se puede hacer una medición de pH y una citología para determinar un índice de maduración vaginal. Cuando estos síntomas se asocian a angustia y molestia se puede estar ante un caso de disfunción sexual, del cual se conocen factores de riesgo para su presencia como la edad como tal, problemas de pareja, estado de salud, autoestima, entre otros. Es por esto que a razón del tratamiento es importante hacer un abordaje interdisciplinario.

Abstract The genitourinary system presents a series of micro and macroanatomical changes from birth, through puberty, reproductive period and finally with menopause, in which a set of systemic symptoms are developed, including vasomotor, sleep, cognitive, mood and sexual changes, associated with the presence of decreased lubrication, narrowing and vaginal distensibility, vaginal atrophy, among others, leading to clinical symptoms of dyspareunia, pruritus, dryness, and urinary symptoms. Its examination involves the realization of a clinical history, physical and gynecological examination. To confirm the changes, a pH measurement can be made and a cytology to determine a vaginal maturation index. When these symptoms are associated with anguish and discomfort, there may be a case of sexual dysfunction, of which there are known risk factors for their presence such as age as such, couple problems, health status, self-esteem, among others. That is why, as to treatment, it is important to make an interdisciplinary approach.

Evaluación preoperatoria / Preoperative evaluation

El texto que sigue muestra el enfrentamiento que tradicionalmente un anestesiólogo hace durante la evaluación preoperatoria de un paciente sea éste de urgencia o electivo. Esto consiste en interiorizarse de la historia, obteniendo la mayor cantidad de información de la condición médica actual y pasada del paciente, un examen físico dirigido, efectuar un análisis sistémico del paciente, solicitar y leer los exámenes pertinentes y dejar las indicaciones apropiadas. Toda la información anterior permitirá clasificar al enfermo de acuerdo a su condición física, evaluar su riesgo y planificar la conducta periopertoria.

These document lineament is given by the traditionally way for an anesthetist to perform the preoperative evaluation of a pacient even if he is an urgency or an elective pacient. This consists in reviewing the history, getting the most information about the present and past medical condition of the pacient, running a guided fisical exam, a sistemic analisis of the pacient, after wich the pertinent exams should be asked and read, then the appropiate indications should de made. All of the previous information will allow a clasification of the pacient acording to his physical condition, evaluate his risk and planning the perioperative.

Efeitos da melatonina no sistema genital feminino: breve revisão / Melatonin effects on the female genital system: a brief review

A melatonina é um hormônio produzido pela glândula pineal, cuja secreção está diretamente relacionada ao ciclo claro-escuro. É um poderoso antioxidante e tem papel fundamental na regulação do estado sono/vigília, do ritmo de vários processos fisiológicos, participando do controle do relógio biológico, inclusive nos seres humanos. Ressalta-se que há evidências da sua ação no sistema genital feminino, influenciando a função ovariana e a fertilidade. De fato, este hormônio interage com esteróides sexuais, como o estrogênio, modificando a sinalização celular e a resposta no tecido alvo. Estudos clínicos sugerem que o tratamento com a melatonina interviria com a evolução de neoplasia-dependente do estrogênio. O objetivo dessa revisão é analisar as principais ações da melatonina no sistema neuroendócrino, no ciclo sono-vigília, no sistema imunológico, no sistema cardiovascular, bem como no sistema reprodutor.

Melatonin is secreted by the pineal gland and this is linked to the day/night cycle. It is an antioxidant and plays a fundamental role in the regulation of the jet-lag stage, in several physiological reactions and in control of the biologic rhythm. Human melatonin has an important influence on the female genital system. In fact, melatonin may influence production and action of steroids, modifying cellular signalization on the target tissue. There are many evidences that the melatonin therapy may be interfering with neoplasia development, mainly of the estrogen-dependent tumor. This paper aims to analyze the actions of melatonin on the neuroendocrine, immunological and cardiovascular systems, as well as on the reproductive function.

Biomedical significance of endothelial cell specific growth factor, angiopoietin

Until recently, vascular endothelial growth factor (VEGF) was the only growth factor proven to be specific and critical for blood vessel formation. Other long-known factors, such as the fibroblast growth factors (FGFs), platelet-derived growth factor, or transforming growth factor-beta, had profound effects in endothelial cells. But such factors were nonspecific, in that they could act on many other cells, and it seemed unlikely that these growth factors would be effective targets for treatment of endothelial cell diseases. A recently discovered endothelial cell specific growth factor, angiopoietin, has greatly contributed to our understanding of the development, physiology, and pathology of endothelial cells (Davis et al., 1996; Yancopoulos et al., 2000). The recent studies that identified and characterized the physiological and pathological roles of angiopoietin have allowed us to widen and deepen our knowledge about blood vessel formation and vascular endothelial function. Therefore, in this review, we describe the biomedical significance of these endothelial cell growth factors, the angiopoietins, in the vascular system under normal and pathological states.

The hindlimb hyperextension associated to the Urogenital response in newborn undefed rats

Background. The aim of the study was to investigate how neonatal undernutrition interacts with mother-infant relationship to interfere with the expression of the urogenital response in the newborn. Methods. The hyperextensive reflex components associated to the urogenital response (HUR) were measured between postnatal days 1-21, in control and neonatally undernourished rats with or without fullness of the bladder. Results. In Experiment 1, both male and female underfed rats with different degress of bladder fullness exhibited an increment in HUR latency and vertical hindlimb displacement, reduced transversal separation and prolonged performance of hindlimb relaxation. Experiment 2 was performed in rats after urine elicitation provoked only reduced hindlimb transversal separation in males, and prolonged latency to HUR in females. Discussion. These findings may be related to the vulneability to neonatal undernutrition of the maturational processes which take place in the spinal cord, the condition of the bladder, and hinleg muscle maturation during this period of life. Conclusions. Data suggest that neonatal undernutrition may play a role in mother-infant interaction by interfering with HUR responses to maternal anogenital licking of pups

Sintomas urinários e genitais em mulheres climatéricas / Urinary and genital symptoms in climaterial women

O estudo objetiva investigar a prevalência de distúrbios urinários e genitais em mulheres climatéricas. Entrevistaram-se 229 mulheres que foram submetids ao exame ginecológico no Ambulatório de Climatério do Centro de Atençäo Integral à Mulher da Universidade Estadual de Campinas, através de questionário detalhado, observando-se variáveis como idade, raça, estado marital, antecedentes tocoginecológicos, uso de anticoncepçäo hormonal, estado mesntrual, uso de terapia de reposiçäo hormonal, cirurgia prévia de incontinência urinária de repetiçäo, diabetes, tabagismo, tosse crônica, quimioterapia eou radioterapia prévia, distopias genitais, trofismo vaginal, muco cervical e teste de Schiller. A freqüência dos distúrbios urinários foi de 42, 8 por cento, sendo o sintoma mais encontrado a incontinência urinária pouco mais da metade das mulheres (54,1 por cento) apresentavam queixas genitais, sendo a secura vaginal a mais freqüente, seguida pela dispaurenia e prurido. Os fatores que se associaram à prevalência de queixas urinárias foram o número de gestaçöes, números de partos e presença de distopias genitais. Já a presença de parceiro, antecedente de diabetes, cirurgia anterior para incontinência urinária, infecçäo urinária de repetiçäo, menor trofismo gential e menor índice de massa corpórea associaram-se à prevalência genitais. Conclui-se que os fatores associados à prevalência de queixas urinárias e genitais säo distintos e que merecem, portanto, uma abordagem diferente dos pontos de vista propedêutico e terapêutico