Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment / Moldes de impressão tridimensionais para agenesia vaginal: Uma abordagem individualizada como tratamento conservador

Abstract Objective The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). Methods A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. Results There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). Conclusion The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.

Resumo Objetivo O objetivo deste estudo foi avaliar o uso de moldes dilatadores vaginais, confeccionados com impressão tridimensional (3D), para tratamento conservador através da dilatação vaginal em pacientes com agenesia vaginal (AV). Métodos Foram selecionadas 16 pacientes com diagnóstico de AV (síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de insensibilidade androgênica total e agenesia cervicovaginal), da Universidade Federal de São Paulo. A produção dos dispositivos foi realizada em uma impressora 3D e, como matéria-prima, foi utilizado o filamento polimérico do poliácido lático (PLA). Um tratamento personalizado foi proposto e desenvolvido para cada paciente. Resultados Quatorze pacientes atingiram um comprimento vaginal final (CVF) de 6 cm ou mais. A média inicial do CVF (DP) foi de 1,81 (1,05) e a média final do CVF (DP) 6,37 (0,94); a diferença (IC 95%) foi de 4,56 (5,27-3,84) e o tamanho do efeito (IC 95%) foi de 4,58 (2,88-6,28). Conclusão Os moldes de impressão 3D para dilatação vaginal obtiveram sucesso em 87,5% das pacientes. Como impacto secundário, não apresentaram efeitos adversos importantes e ofereceram uma estratégia econômica, acessível e reprodutível para o tratamento da AV.

Anatomia do sistema reprodutor feminino de Alouatta belzebul (Linnaeus, 1766) / [Anatomy of the female reproductive system of the Alouatta belzebul (Linnaeus, 1766)]

O conhecimento da anatomia de qualquer animal silvestre é de fundamental importância para sua preservação e proteção. Neste contexto, o presente estudo objetivou descrever a morfologia do sistema reprodutor feminino de Alouatta belzebul. Foram utilizados seis espécimes de A. belzebul, fêmeas, adultas, e livres de lesões. Observou-se macroscopicamente que os ovários têm características morfológicas em formato ovoides, com superfície lisa, e, na análise histológica na região de córtex, evidenciou-se folículos ovarianos em diferentes estágios de desenvolvimento. As tubas uterinas anatomicamente são finas e curvilíneas, apresentando uma camada mucosa, uma muscular e outra serosa. O útero possui formato simples, com fundo globoso, com um miométrio altamente vascularizado, sendo organizado em feixes de fibras musculares lisas. A estrutura anatômica da vagina apresentou-se como um tubo muscular longo de paredes finas, onde, na região vestibular, o óstio externo da uretra é marcado por uma papila uretral bilobada e, na região de vulva, em sua porção caudal, contatou-se um clitóris bem desenvolvido. No que concerne à análise histológica da vagina, verificou-se, em região de mucosa vaginal, um extrato basal composto por epitélio estratificado pavimentoso não queratinizado atrófico. As descrições morfológicas fornecem, de forma inédita, informações importantes relativas à anatomia macroscópica e microscópica do sistema reprodutor feminino dessa espécie.(AU)

Knowledge of the anatomy of any wild animal is of fundamental importance for its preservation and protection. In this context the present study aimed to describe the morphology of the female reproductive system of A. belzebul. We used 6 specimens of A. belzebul, female, adult and free of lesions. It was macroscopically observed that the ovaries are ovoid with smooth surface and the histological analysis in cortical region showed ovarian follicles in different stages of development. The fallopian tubes are anatomically thin and curvilinear, with one mucous layer, one muscular and one serous layer. The uterus was presented in a simple format with a globular fundus, with a highly vascularized myometrium, being organized in bundles of smooth muscle fibers. The anatomical structure of the vagina presented itself as a long thin-walled muscular tube where in the vestibular region the external orifice of the urethra is marked by a bilobed urethral papilla and in the caudal portion in its caudal portion a well-developed clitoris. Regarding the histological analysis of the vagina, a basal extract composed of atrophic non-keratinized stratified squamous epithelium was found in the vaginal mucosa region. The morphological descriptions provide important information regarding the macroscopic and microscopic anatomy of the female reproductive system of this species in an unprecedented way.(AU)

La vagina como sitio de extracción y puerto laparoscópico en NOSE y NOTES / The vagina as an extraction site and laparoscopic port in NOSE and NOTES

El objetivo del presente estudio es evaluar nuestra experiencia inicial utilizando la vagina para el retiro de especímenes quirúrgicos o como puerto laparoscópico en intervenciones de cirugía a través de orificios naturales (NOTES). Métodos: Analizamos retrospectivamente los datos de pacientes femeninos, intervenidos en el Instituto Medico La Floresta, Caracas, Venezuela, desde Junio de 2009 a junio de 2015. Dichos pacientes fueron sometidas a intervenciones involucrando resecciones laparoscópicas de órganos sólidos como pancreatectomías distales, esplenectomías y miomectomías uterinas, utilizando la vagina como sitio de extracción. También incluimos pacientes sometidas a apendicectomía transvaginal híbrida NOTES y a colecistectomía transvaginal híbrida. Reportamos el procedimiento técnico, las complicaciones relacionadas con el acceso transvaginal y el seguimiento clínico. Resultados: Cuatro pacientes fueron sometidas a pancreatectomía distal con esplenectomía, siete a esplenectomía laparoscópica, cuatro casos fueron resecciones de masas anexiales y seis miomectomías uterinas. Tres pacientes fueron intervenidas para apendicectomía laparoscópica hibrida transvaginal y cuatro a colecistectomía hibrida trans-vaginal. En todos los casos el espécimen quirúrgico fue retirado a través de la vagina. Todas las pacientes reportaron manchado vaginal mínimo por un máximo de 14 días (media de 8), sangramiento escaso durante el coito por un máximo de 54 días (media de 32) y ninguna paciente reportó dispareunia u otras molestias relacionadas con el acceso vaginal a los seis meses. Conclusiones: El uso de la vagina como sitio de extracción para especímenes quirúrgicos es posible y seguro, incluso en casos de órganos sólidos o especímenes contaminado(AU)

The objective of this study is to evaluate our initial experience, using the vagina, for the removal of surgical specimens, or as a laparoscopic port in surgical interventions through natural orifices "NOTES" or (natural orifice translumenal endoscopic surgery). Methods: We retrospectively analyzed data from female patients operated at the La Floresta Medical Institute in Caracas, Venezuela, from June 2009 to June 2015, who underwent interventions involving laparoscopic resections of solid organs, such as distal pancreatectomies, splenectomies, and uterine myomectomies. Using the vagina as an extraction site. We also included patients undergoing hybrid NOTES trans-vaginal appendectomy and hybrid trans-vaginal cholecystectomy. We report the technical procedure, complications related to trans-vaginal access and clinical follow-up. Results: Four patients underwent distal pancreatectomy with splenectomy, seven underwent laparoscopic splenectomy, four cases were resections of adnexal masses and six were uterine myomectomies. Three patients underwent surgery for trans-vaginal hybrid laparoscopic appendectomy and four for trans-vaginal hybrid cholecystectomy. In all cases, the surgical specimen was removed through the vagina. All patients reported minimal vaginal blood spotting for a maximum of 14 days (average of 8), scarce bleeding during intercourse for a maximum of 54 days (average of 32), and no patient reported dyspareunia or other discomfort related to vaginal access after six months. Conclusions: The use of the vagina as an extraction site for surgical specimens is possible and safe, even in cases of solid organs or contaminated specimens(AU)

Descripción histológica del aparato reproductor de avestruz hembra (Strutio camelus var. domesticus) / Histological description of the ostrich female reproductive system (Strutio camelus var. domesticus)

El auge de la producción intensiva del avestruz, comenzó en la década de los noventa impulsada por la calidad de su carne y potencialidad de sus subproductos. La raza empleada para producción por la calidad nutricional y sabor de su carne es el híbrido llamado African black (Struthio camelus var. domesticus). En cuanto a la reproducción, el avestruz hembra alcanza su madurez sexual a partir de los 2,5 años. Es importante considerar el aparato genital en aves de producción, ya que una alteración en él, puede generar deficiencias en la fertilidad que se traducen en un menor número de crías. El estudio histológico del aparato reproductor de la hembra será una herramienta más que permitirá resolver problemas reproductivos. Para este análisis se obtuvo muestras de los diferentes segmentos del aparato reproductor de 6 avestruces hembras en edad reproductiva y se procesaron de acuerdo a las técnicas histológicas de rutina. Los cortes fueron observados, fotografiados y analizados bajo microscopio de luz. Obtenidas las fotografías, se analizó comparativamente su morfología con la descrita en la gallina (Gallus gallus). El aparato reproductor de la hembra tiene la particularidad de tener desarrollado solo el ovario y oviducto izquierdo. El ovario es de gran tamaño y en forma de racimo, el cual varía según la estacionalidad. Presenta folículos primordiales, previtelogénicos, vitelogénicos y atrésicos. Los folículos vitelogénicos presentan células de la granulosa y de la teca interna y externa. El oviducto presenta de cefálico a caudal los siguientes segmentos: infundíbulo, magnum, istmo, útero y vagina, que desemboca en la cloaca a nivel del urodeo. En ellos hay pliegues de variada longitud, grosor y número que comprometen la mucosa y submucosa, con glándulas de secreción mucosa y serosa a excepción de la vagina. El análisis histológico comparativo, permitió establecer que la morfología del aparato reproductor de la hembra es semejante a la observada en la gallina con ciertas diferencias microscópicas (Gallus gallus).

In the 1990's, ostrich production reached a peak in our country, boosted by the special characteristics of its meat and the potential of the derivatives. The breed raised is a hybrid called African Black (Struthio camelus var. domesticus) which has a high quality meat in terms of nutritional factors and flavor. With regard to reproduction, the female ostrich reaches maturity at the age of 2.5 years. Genital organs are very important in fowl's production, because they can generate fertility deficiencies that, in turn can diminish brood number. Histological analysis allows a better understanding of the basic structure of the female's genital organs and is a helpful tool to resolve breeding problems. For this analysis samples were obtained from the different segments of the reproductive system of 6 female ostrich in reproductive age. These samples were processed using standard histological technique. Sections were observed, photographed and analyzed under the light-microscope. Photographs were compared with hen's samples. The ostrich female's reproductive system has the particularity of having just the left ovary and oviduct developed. The ovary has a big size and a cluster shape which varies from season to season. It presents paramount, previtellogenic, vitellogenic and atresic follicles. The vitellogenic follicles have granulosa cells and inner and external theca. The oviduct presents cephalocaudally: infundibulum, magnum, isthmus, uterus and vagina, flowing into the urodeum. It shows long pleats of different length and number, with drusen of mucose and serose secretion, except in the vagina. The comparative histological analysis allowed us to establish that the basic structure of the female reproductive system is similar to that of the hen (Gallus gallus).

Histological characterization of reproductive tract and fetal annexes of the West Indian Manatee (Trichechus manatus) from Brazil / Caracterização histológica do trato reprodutor e anexos fetais do peixe-boi marinho (Trichechus manatus) do Brasil

The West Indian manatee (Trichechus manatus) is one of the most threatened aquatic mammals in Brazil, and is currently classified as "endangered" (MMA). The objective of this study was to characterize histologically the reproductive tract and fetal annexes of stranded manatees in northeastern Brazil. Tissue samples were collected from the reproductive tract of 23 manatees, which were fixed in 10% buffered formalin, processed using standard histological protocols and stained with hematoxylin eosin. We qualitatively described the histological and histomorphometric characteristics of each structure. Six ovaries were analyzed. In four ovaries, we found a large number of primordial and primary follicles. Two ovaries were different from the others: one had inflammatory infiltration and the other had a thickening in the cortex and absence of follicles. We also analyzed seven uteri (of which four were in the proliferative phase, two in the secretory phase, and one in the recovery phase), four placentas, one vagina, six testes (four were in the immature phase, one in the pubertal phase, and one in the mature phase), two epididymides, two penises, and one umbilical cord. The histological and morphometric findings in our work will support future analyses of the reproductive tract of T. manatus from Brazil.(AU)

O peixe-boi marinho (Trichechus manatus) é um dos mamíferos aquáticos mais ameaçados do Brasil e, atualmente é classificado como "em perigo" (MMA). O objetivo deste estudo foi caracterizar histologicamente o trato reprodutor e os anexos fetais de peixes-bois marinhos encalhados no Nordeste do Brasil. Foram coletadas amostras de tecidos do trato reprodutor de 23 peixes-bois marinhos (T. manatus), que foram fixadas em formol tamponado a 10%, processados usando protocolos histológicos padrão e corados com hematoxilina eosina. Foi realizada a descrição qualitativa das características histológicas e histomorfométricas de cada estrutura. Foram analisados seis ovários. Em quatro ovários, foi encontrado um grande número de folículos primordiais e primários. Dois ovários eram diferentes dos outros: um tinha infiltração inflamatória e o outro tinha um espessamento no córtex e ausência de folículos. Também foram analisadas sete amostras uterinas (das quais quatro estavam na fase proliferativa, duas na fase secretória e uma na fase de recuperação), quatro placentas, uma vagina, seis testículos (quatro na fase imatura, um na fase puberal e um na fase madura), dois epidídimos, dois pênis e um cordão umbilical. Os achados histológicos e morfométricos em nosso trabalho apoiarão futuras análises do trato reprodutivo de T. manatus do Brasil.(AU)

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

A síndrome de Williams-Beuren (WBS) é uma doença genética rara, acometendo, aproximadamente, de 1:20.000 a 1:50.000 crianças nascidas. As crianças com WBS têm deformidades esqueléticas específicas, má formações dentárias e, algumas vezes, disfunção muscular da língua. As necessidades ortodônticas e ortognáticas têm sido consideradas um verdadeiro desafio clínico, até mesmo para aqueles profissionais com vasta experiência, uma vez que requerem um plano de tratamento individualizado e complexo. Esse relato de caso aborda uma expansão ortopédica da maxila, em que foi utilizada uma máscara facial modificada para protração do complexo maxilar, acompanhada de uma rotação horária da maxila. Além disso, considerações especiais sobre o tempo de tratamento e resultados ortopédicos são discutidas.

Characterization of the estrous cycle in Galea spixii(Wagler, 1831) / Caracterização do ciclo estral de Galea spixii (Wagler, 1831)

The Galea spixii inhabits semiarid vegetation of Caatinga in the Brazilian Northeast. They are bred in captivity for the development of researches on the biology of reproduction. Therefore, the aim of this study is characterize the estrous cycle of G. spixii, in order to provide information to a better knowledge of captive breeding of the species. The estrous cycle was monitored by vaginal exfoliative cytology in 12 adult females. After the detection of two complete cycles in each animal, the same were euthanized. Then, histological study of the vaginal epithelium, with three females in each phase of the estrous cycle was performed; five were paired with males for performing the control group for estrous cycle phases, and three other were used to monitor the formation and rupture of vaginal closure membrane. By vaginal exfoliative cytology, predominance of superficial cells in estrus, large intermediate cells in proestrus, intermediate and parabasal cells, with neutrophils, in diestrus and metestrus respectively was found. Estrus was detected by the presence of spermatozoa in the control group. By histology, greater proliferation of the vaginal epithelium in proestrus was observed. We conclude that the estrous cycle of G. spixii lasts 15.8 ± 1.4 days and that the vaginal closure membrane develops until complete occlusion of the vaginal ostium, breaking after few days. Future studies may reveal the importance of this fact for the reproductive success of this animal...

Os Galea spixii habitam a vegetação semiárida da Caatinga, no Nordeste brasileiro. Eles são criados em cativeiro para realização de pesquisas relacionadas a biologia da reprodução. Sendo assim, o objetivo deste trabalho foi caracterizar o ciclo estral de G. spixii para obtenção de informações que melhorem o conhecimento do manejo reprodutivo da espécie em cativeiro. O ciclo estral foi monitorado por citologia esfoliativa vaginal em doze fêmeas adultas. Após a detecção de dois ciclos completos em cada animal, os mesmos foram eutanasiados. Em seguida foi realizado estudo histológico do epitélio vaginal com três fêmeas em cada fase do ciclo estral; cinco foram pareadas com machos para realização do grupo controle e outras três fêmeas foram utilizadas para monitorar a formação e ruptura da membrana de oclusão vaginal. Através de citologia esfoliativa vaginal, constatou-se predomínio de células superficiais em estro, células intermediárias grandes em proestro, células intermediárias pequenas e células parabasais com presença de neutrófilos em diestro e metaestro, respectivamente. O estro foi detectado pela presença de espermatozoides no grupo controle. Através de histologia, observou-se uma maior proliferação no epitélio vaginal no proestro. Concluiu-se que o ciclo estral de G. spixii dura em média 15.8 ± 1.4 dias e a membrana de oclusão vaginal se desenvolve até completa oclusão do óstio vaginal externo, rompendo-se em poucos dias. Futuros estudos podem revelar a importância deste último fato para o sucesso reprodutivo deste animal...

Histometric parameters of uterus and vagina in breeder female rabbits on the day after weaning according to the ordinal number of parturitions / Parámetros histométricos en útero y vagina de conejas reproductoras en el día posterior al destete según el número ordinal de partos

The objective of this study was to establish in New Zealand female rabbits, the effect of ordinal number of parturitions on some histological parameters on the day after weaning. Tissue fragments of uterus and vagina were obtained from females of first, second and third parturitions and were processed imbedding them in paraffin in order to do histological cuts. In eight microscope fields captured by a camera connected to an optic microscope, the lumen and glandular endometrial epithelium height, as well as the thickness of vaginal and myometrium epithelium thickness were measured. From the results that were obtained it was concluded that there are significant differences (p<0.05) in histological parameters evaluated in uterus and vagina between does of different parturitions, which indicates that the number of parturitions has an effect on histometric characteristics of genital tract organs in breeder female rabbits.

El objetivo del presente estudio fue determinar en conejas Nueva Zelanda el efecto del número ordinal de partos sobre algunos parámetros histológicos, en el día posterior al destete. A partir de hembras de primero, segundo y tercer parto se obtuvieron fragmentos de tejido uterino y vaginal los que se procesaron mediante la técnica de inclusión en parafina para efectuar cortes histológicos. En ocho campos microscópicos capturados con una cámara conectada a un microscopio óptico se midió la altura del epitelio luminal y glandular del endometrio; el grosor del epitelio de la vagina y del miometrio. A partir de los resultados obtenidos se concluye que existen diferencias significativas (p<0,05) en los parámetros histológicos evaluados en útero y vagina entre las conejas de distintos partos, lo que indica que el número de partos tiene un efecto sobre las características histométricas de los órganos del tracto genital de la coneja.

Female Longitudinal Anal Muscles or Conjoint Longitudinal Coats Extend into the Subcutaneous Tissue along the Vaginal Vestibule: A Histological Study Using Human Fetuses

PURPOSE: It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. MATERIALS AND METHODS: Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. RESULTS: In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. CONCLUSION: In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.

Citologia vaginal de preguiça-de-coleira (bradypus torquatus) / Vaginal cytology of maned sloth (bradypus torquatus)

As preguiças-de-coleira (Bradypus torquatus) são mamíferos arborícolas da família Bradypodidae. Podem ser encontradas nos trechos de Mata Atlântica do Brasil e a maior diversidade genética de suas populações ocorre em matas do sul da Bahia. A observação desses animais na natureza é muito difícil, pois passam a maior parte da vida escondidos no denso emaranhado das copas, por isso, dados sobre aspectos reprodutivos são escassos e não existem informações sobre ciclo estral dessa espécie. Este trabalho teve por objetivo identificar as células do epitélio vaginal da preguiça-de-coleira (Bradypus torquatus) como forma de viabilizar o uso dessa técnica para estudar as fases do ciclo estral desses animais. As amostras para citologia vaginal foram obtidas de quatro preguiças de coleira que habitavam áreas de Mata Atlântica do sul da Bahia. Após captura manual do animal, procedeu-se a coleta de material biológico, introduzindo uma escova ginecológica estéril, na comissura dorsal da vulva. Para cada amostra foram feitos dois esfregaços rotacionando a extremidade da escova sobre cada lâmina de vidro, fazendo-se em geral três impressões lineares. O esfregaço foi imediatamente corado pelo método Panótico rápido (Laborclin®). Nas preguiças BT033, BT065 e BT042 foi possível identificar respectivamente 30%, 33% e 7% de células parabasais (PB); 56%, 22% e 10% de células intermediárias pequenas (IP); 6%, 18% e 6% de células intermediárias grandes (IG); 2%, 13% e 24% de células superficiais nucleadas (SN); 6%, 14% e 53% de células superficiais anucleadas (SA). Na preguiça BT464 foi possível fazer duas coletas com intervalo de 13 meses. Os dados da primeira e segunda coleta foram, respectivamente: 6% e 17,5 de células PB, 5% e 25% de células IP, 11% e 15,5% de células IG, 8% e 19,5% de células SN e 70% e 22,5% de células SA. Enfatiza-se que as porcentagens de células do epitélio vaginal variaram entre indivíduos e também na mesma preguiça. Isto sugere que a citologia vaginal possa ser uma ferramenta de avaliação do ciclo estral em preguiça-de-coleira.

Maned sloths (Bradypus torquatus) are arboreal mammals of the family Bradypodidae. They can be only found in the Atlantic coast forest of Brazil and its most genetically diverse populations occur in forests of southern Bahia. The observation of these animals in the wild is very difficult as they spend most of their lifetime hidden in the dense forest canopy. Data on their reproductive aspects are scarce, and there is none information about their estrous cycle. This research aimed at identifying the vaginal epithelial cells of maned sloths (Bradypus torquatus) as a possible way to study the phases of the estrous cycle of this animal. The samples for vaginal cytology were obtained from four free ranging maned sloths living in a protected area of coastal forest in the South of Bahia. The sterile gynecological brush was inserted up to the necessary distance to reach the pelvic channel. For each sample two smears were made by rotating the tip of the brush onto each glass slide, producing in general three linear impressions. Staining was performed using rapid Panotic Kit (Laborclin®). Maned sloths BT033, BT065, and BT042 presented, respectively, 30%, 33%, and 7% of parabasal epithelial cells (PB); 56%, 22%, and 10% of small intermediate cells (IP); 6%, 18%, and 6% of large intermediate cells (IG); 2%, 13%, and 24% of superficial epithelial cell with a nucleus (SN); 6%, 14%, and 53% of anucleated superficial epithelial cell (AS). Two cell samples were collected for maned sloth BT464 with a 13 months interval. Cytological differences were observed between the two samples (1st and 2nd): 6% and 17,5% of PB cells, 5% and 25% of IP cells, 11% and 15,5% of IG cells, 8% and 19,5% of SN cells and 70% and 22,5% of AS cells, respectively. It’s interesting to remark that the percentage of vaginal epithelial cells varied among sloths and also for the same animal. This result suggests that vaginal cytology of maned sloth can be used as a tool to evaluate of estrous cycle.

Detecção de estro em jaguatirica (Leopardus pardalis) utilizando citologia vaginal / Vaginal cytology for estrus detection in ocelot (Leopardus pardalis)

Utilizou-se a citologia vaginal por meio de diferentes métodos de coloração para detecção de cio em jaguatirica, Leopardus pardalis, pela estimulação hormonal exógena e pela avaliação das estruturas ovarianas por videolaparoscopia. Cinco fêmeas foram tratadas com eCG/hCG e FSH/LH a cada quatro meses pelo período de dois anos. Videolaparoscopia foi realizada após cada tratamento utilizando-se cetamina-xilazina e isoflurano. Esfregaços vaginais foram obtidos 15 dias antes e após a videolaparoscopia. As lâminas foram analisadas ao microscópio de luz quanto aos tipos celulares predominantes. Todos os animais apresentaram folículos maduros (>2mm) e corpos lúteos recentes em todas as intervenções. Não houve diferença significativa entre os resultados obtidos na mesma coloração de acordo com os tratamentos utilizados. Todas as técnicas mostraram-se eficientes na detecção de células superficiais queratinizadas anucleadas e nucleadas, intermediárias, parabasais e basais. Foi possível determinar a fase de estro em Leopardus pardalis por meio da citologia vaginal.

Vaginal cytology was evaluated for estrus detection using different stains after hormonal stimulation with exogenous gonadotrophin (eCG/hCG, FSH/LH) and videolaparoscopy for ovarian structure evaluation. Five L. pardalis were treated four times during two years. After each treatment, videolaparoscopy was performed using Ketamine-Xylazine and Isoflurane. Vaginal cytology was made 15 days before and after videolaparoscopy. Three stains were used: Diff Quick, Papanicolaou, and Shorr. The slides were analyzed for the typical cell predominance. All the animals showed mature follicles (>2mm) and recent corpus luteum in all procedures. No significative difference was observed between the results in the same stain according to the treatment eCG/hCG and FSH/LH. All stains were efficient in detection of nucleated and anuclear superficial keratinized cells; intermediated, parabasal, and basal cells. Vaginal cytology can be used for estrus detection in Leopardus pardalis.

Notes: colecistectomía trans-vaginal video asistida: con instrumentos laparoscópicos convencionales: descripción de la técnica quirúrgica / Notes: video assisted trans-vaginal cholecystectomy with conventional laparoscopic instruments: a description of surgical technique

Las vías de abordaje para la realización de la colecistectomía han cambiado dramáticamente en los últimos 20 años, desde la cirugía abierta hasta la cirugía de invasividad mínima y ahora desde 2007 se comienza a realizar cirugía a través de orificios naturales. Con la ausencia de instrumentos ideales, puede ser posible crear accesos seguros a través del abordaje trans-vaginal con el uso de instrumentos laparoscópicos convencionales en pacientes bien seleccionados. Describir una nueva técnica quirúrgica para la realización de colecistectomía transvaginal video asistida con instrumentos laparoscópicos convencionales. Descripción de la técnica: con la paciente bajo anestesia general, colocada en posición ginecológica, accedemos a la cavidad abdominal a través de la cicatriz umbilical. Insertando un trocar de 10mm bajo visión directa, a través de este se vigilará la entrada a través de la colpotomía, a través de la vagina se introducirá una pinza de grasper de 5mm y la óptica de 30°. Con el grasper transvaginal se sujetara la vesícula y a través del portal umbilical el cirujano realizará la disección de los elementos de triangulo de Calot, extrayendo la pieza por vía vaginal. El acceso trans-vaginal es factible y seguro con material laparoscópico convencional, para la realización de colecistectomía. Es indispensable el entrenamiento en laparoscopia convencional. El cirujano debe adaptarse a los ángulos de visualización ofrecidos.

The access to perform a cholecystectomy has changed dramatically in the last 20 years, from open surgery to minimal invasive surgery such as laparoscopy and now since 2007, starting toperform through natural orifices. In the absence of ideals instruments, it could be possible to create safes access through trans-vaginal way with regular laparoscopic instruments in well selected patients. Describe a new surgical technique to perform a trans-vaginal cholecystectomy video assisted, with common laparoscoic instruments. Technical description: with the patient under general anesthesia, placed her in gynecological position, we get access to the abdominal cavity through umbilicus, inserting a 10mm trocar, them under direct vision we perform the trans-vaginal access inserting one grasping forceps and 30º scope. The vaginal grasping forceps will hold the gallbladder between the fundus and the infundibulus, exposing the Calot triangle. Through the umbilicus trocar the surgeon dissect de cystic duct and artery, them it will be separated from its bed. The gallbladder is taking out side from the abdomen through vaginal way. The trans-vaginal access is a feasibly way to perform cholecystectomy with common laparoscopic instruments. It is indispensable to dominate basic laparoscopic techniques, and before start practicing this procedure, it has to perform under animal’s models.

Aspectos citológicos, histológicos e morfológicos de neovaginas de mulheres e transmulleres / Cytological, histological and morphological aspects of women and transwomen

O estudo das neovaginas em mulheres e principalmente em transexuais masculinos operados inclui pequeno número de casos e conta com pouco detalhamento sobre o assunto. Algumas perguntas ainda estão por ser respondidas: é necessária a colpocitologia oncoparasitária? Se necessária, em que espaço de tempo? Devemos nos preocupar com a infecção pelo HPV? Quanto tempo é necessário para haver a completa metaplasia do epitélio utilizado? A flora bacteriana é semelhante? Com o objetivo de chamar a atenção para o tema, realizamos uma revisão bibliográfica, abordando aspectos cirúrgicos, oncocitopatológicos, histológicos e morfológicos de neovaginas de mulheres biológicas e transmulheres (transexuais masculinos).

The neovagina studies in women and mainly in operated male transsexuals (transwomen) are few and with few cases specified. Their follow-up is also difficult. Some questions have not been answered yet: is the oncologic colpocytology necessary? If it is necessary, what would the best time to do it? Shall we be worried about HPV infection? What is the necessary time to completely metaplasia? Is the bacterial flora similar? With the purpose of calling attention to this subject, we made a bibliography revision approaching cytological, histological and morphologic aspects of women and transwomen neovaginas (male-to-female transsexual).

Role of mid-trimester transvaginal cervical ultrasound in prediction of preterm delivery.

The objective of this study was Transvaginal Ultrasonography (TVS) to examine the potential of routine measurement of cervical parameters by TVS at mid-trimester to predict preterm delivery. Cervical parameters measured by TVS at 20-24 weeks were critically analyzed for their ability to predict spontaneous preterm birth. The risk of spontaneous preterm delivery increased steeply as cervical length decreased. At a cut off value of d<2.5 cm, the cervical length measurements had sensitivity, specificity, positive predictive value and negative predictive value of 77%, 95%, 56% and 98% respectively. Our data suggests that the duration of pregnancy is directly related to length of the cervix, the shorter the cervix, the greater the chance of preterm delivery.

Aspectos de imagem das lesões vulvo-vaginais / Imaging of the vagina and vulva

Na pratica ginecológica diária, a vulva e a vagina são examinadas durante inspeção visual, entretanto, há situações em que isso não é possível ou que se necessita determinar a extensão de umalesão através de métodos de imagem. A ressonância magnética é um método excelente e cada vez é mais indicado na avaliação de alterações da vulva e vagina, em virtude da sua capacidade deavaliação multiplanar e alto contraste tecidual, fornecendo informações que auxiliam o ginecologista. Outros métodos de imagem que podem ser indicados são a ultra-sonografia e a tomografia computadorizada da pelve. Este trabalho pretende, de forma sintética, analisar as principais alterações vulvo-vaginais que podem ser identificadas e diagnosticadas pelo radiologista.

In gynecological daily practices, the vulva and vagina are examined during physical examination, however there are situations where this is not possible or it is needed to determine the extension of an injury through imaging methods. The magnetic resonanceimaging is an excellent cross-sectional modality for evaluation the alterations of vulva and vagina due its multiplanar evaluation and high tecidual contrast. Other cross-sectional modalities are ultrasound and enhanced computed tomography. This paper intends togive an overview of vaginal and vulvar pathology that can be identifiedby the radiologist.

Dispareunia post-histerectomía total abdominal: relación anatómica / Dyspareunia after total abdominal hysterectomy: anatomical relation

Objetivo: conocer si los cambios anatómicos poshisterectomía total abdominal producen dispareunia en pacientes premenopáusicas. Material y métodos: estudio comparativo, prospectivo, longitudinal, de 50 pacientes premenopáusicas sometidas a histerectomía total abdominal por enfermedad uterina benigna sin dispareunia prequirúrgica. Se realizaron valoraciones pre y posperatorias del volumen vaginal y de las longitudes vaginales izquierda, derecha, anterior y posterior. El análisis estadístico se llevó a cabo por medidas de tendencia central y prueba t, agrupando a las pacientes en dos grupos: con dispareunia posoperatoria (grupo I) y sin dispareunia posoperatoria (grupo II). Resultados: grupo I, tres pacientes con los siguientes valores preoperatorios y posoperatorios: volumen vaginal de 146.6 y 100 cm3, longitud vaginal anterior de 8 y 7.3 cm, posterior de 9.16 y 7.3 cm, izquierda de 8 y 7.3 cm, y derecha de 8 y 7.3 cm. Grupo II, 47 pacientes con los siguientes valores preoperatorios y posoperatorios: volumen vaginal de 150.6 y 121.6 cm3, longitud vaginal anterior de 8.81 y 8.12 cm, posterior de 9.7 y 8.69 cm, izquierda de 9.24 y 8.3 cm, y derecha de 9.28 y 8.33 cm. Entre los grupos no encontramos diferencias estadísticamente significativas en volumen ni longitudes vaginales. En dos casos con dispareunia se encontró granuloma en cúpula vaginal que remitió con la resección; en otro no hubo implicación anatómica Conclusiones: no existió relación entre la dispareunia y los cambios de volumen y longitudes vaginales poshisterectomía. El granuloma en la cúpula vaginal fue responsable de 4 % de dispareunia. La dispareunia poshisterectomía total abdominal en paciente premenopáusicas sin causa anatómica aparente se presentó en 2 %.

BACKGROUND: We undertook this study to determine whether anatomic changes after total abdominal hysterectomy are a cause of dyspareunia in premenopausal women. METHODS: This is a comparative, prospective and longitudinal study in 50 premenopausal women with benign uterine disease without dyspareunia treated with total abdominal hysterectomy. Primary variable was presence of postsurgical dyspareunia. Secondary variables are presurgical and assessment 3 months after surgery of left, right, anterior and posterior vaginal longitude (VLL, VRL, VAL and VPL, respectively) expressed in centimeters, as well as of the vaginal volume (VV). Statistical analysis for mean, central tendency and t-test. Group 1 (G1) is comprised of patients with postsurgical dyspareunia and Group 2 (G2) is comprised of patients without dyspareunia. RESULTS: In G1, three patients (mean age: 42 years) had dyspareunia, pre- and postsurgical mean values were VV 146.6 and 100, VLL 8 and 7.3, VPL 9.16 and 7.3, VLL 8 and 7.3, VRL 8 and 7.3. In G2, 47 patients (mean age: 40.36 years) were without dyspareunia, pre- and postsurgical values were VV 150.6 and 121.57, VLL 8.81 and 8.12, VPL 9.7 and 8.69, VLL 9.24 and 8.3, VRL 9.28 and 8.33. We did not find significant differences between the groups. Two of the three patients with dyspareunia had a vaginal granuloma, but the third case did not show an anatomical cause. CONCLUSIONS: There is no relationship between total abdominal hysterectomy in premenopausal women and anatomical vaginal changes after surgery as assessed by vaginal volume and longitude. Presence of vaginal granuloma was responsible for dyspareunia in 4% of cases. Dyspareunia was found in 2% of premenopausal women without posthysterectomy anatomical cause.

Influence of ovariectomy and flutamide treatment on vaginal tissue and body weight

To determine the effect of flutamide on vaginal histology, and to ascertain whether flutamide regulates body weight gain in the ovariectomized rat model. We chose 36 sexually mature female Wistar-Albino rats in this study. The study took placed in the Department of Medical Science Application and Research Center of Dicle University, Diyarbakir, Turkey, in 2002. We divided the model rats into 3 groups: group 1 - control group, group 2 - sham-operated group and group 3 - bilaterally ovariectomized group. In addition, we gave flutamide to group 3. We found that the body weight was higher in the ovariectomized rats than the control rats. Furthermore, the body weight decreased a little after flutamide therapy. The thickness in the vaginal epithelium of the control group decreased, moreover, the appearance of stromal tissue was rather loose. After flutamide applications, infiltration of the stromal cells increased, the vaginal epithelial layer thickened and became keratinized. Microscopic papillae and anatomical processes appeared in the flutamide treated group. We observed that the antiandrogen drug flutamide is hormonally active and may exhibit estrogenic-antiestrogenic activity in rats. Our study may be a source for further research examining the relationship between the androgen receptor antagonist flutamide and reproductive function in female rats

Morphological study of the female external genitalia of the myocastor coypus

El objetivo de este trabajo fue realizar el estudio morfológico de los órganos genitales externos de myocastor coypus (coipo). la vulva se presentó rudimentaria y limitada por dos repliegues de escaso desarrollo. Su superficie externa presentó una cubierta de pelos largos y escasos. En la superficie interna de la vulva no hubo pigmentación ni cubierta pilosa. El revestimiento del área vulvar mostró un epitelio escamoso, estraficado, apoyado sobre una lámina propia con papilas microscópicas. En la lámina propia se observaron abundantes y pequeñas glándulas de aspectos sebáceo asociadas a los folículos pilosos. El clítoris fue una estructura cónica prominente, con un glande pequeño y recubierto por el prepucio del clítoris. El prepucio, de superficie rugosa y consistencia blanda y flexible, se proyectó en punta hacia ventral. El clítoris presentó un cuerpo cavernoso bien desarrollado, con tejido muscular en su zona basal, conformando el cuerpo del clítoris. El eje del cuerpo del clítoris presentó un núcleo alargado de cartílago hialino. La abertura uretral se observó a dorsal del clítoris, por detrás del glande

Studies on safety aspects of contraceptive Magainin-A in rabbits.

We have previously reported the contraceptive potential of Magainin-A in rats and rabbits under in vitro and in vivo condition. In this report we evaluated the effect of Magainin-A on the structural organisation of vaginal epithelium in rabbits. The effect of this compound on the erythrocytes and its rate of absorption and clearance from systemic circulation was also studied. The effective contraceptive dose of Magainin-A (1 mg) when administered intra-vaginally for five consecutive days did not induce any structural or morphological abnormalities in vaginal epithelial cells. No adverse effect was observed on the erythrocytes. The rate of Magainin-A absorption and clearance from the circulation was found to be rapid. These results suggest that Magainin-A may be used as a safe intra-vaginal contraceptive compound in future.