Effect of thermophilic bacterium HB27 manganese superoxide dismutase in a rat model of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) / 亚洲男科学杂志(英文版)

We investigated the therapeutic effects of superoxide dismutase (SOD) from thermophilic bacterium HB27 on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its underlying mechanisms. A Sprague-Dawley rat model of CP/CPPS was prepared and then administered saline or Thermus thermophilic (Tt)-SOD intragastrically for 4 weeks. Prostate inflammation and fibrosis were analyzed by hematoxylin and eosin staining, and Masson staining. Alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (CR), and blood urea nitrogen (BUN) levels were assayed for all animals. Enzyme-linked immunosorbent assays (ELISA) were performed to analyze serum cytokine concentrations and tissue levels of malondialdehyde, nitric oxide, SOD, catalase, and glutathione peroxidase. Reactive oxygen species levels were detected using dichlorofluorescein diacetate. The messenger ribonucleic acid (mRNA) expression of tissue cytokines was analyzed by reverse transcription polymerase chain reaction (RT-PCR), and infiltrating inflammatory cells were examined using immunohistochemistry. Nuclear factor-κB (NF-κB) P65, P38, and inhibitor of nuclear factor-κBα (I-κBα) protein levels were determined using western blot. Tt-SOD significantly improved histopathological changes in CP/CPPS, reduced inflammatory cell infiltration and fibrosis, increased pain threshold, and reduced the prostate index. Tt-SOD treatment showed no significant effect on ALT, AST, CR, or BUN levels. Furthermore, Tt-SOD reduced inflammatory cytokine expression in prostate tissue and increased antioxidant capacity. This anti-inflammatory activity correlated with decreases in the abundance of cluster of differentiation 3 (CD3), cluster of differentiation 45 (CD45), and macrophage inflammatory protein 1α (MIP1α) cells. Tt-SOD alleviated inflammation and oxidative stress by reducing NF-κB P65 and P38 protein levels and increasing I-κBα protein levels. These findings support Tt-SOD as a potential drug for CP/CPPS.

Syringoceles of Cowper's ducts and glands in adult men / 亚洲男科学杂志(英文版)

Cowper's syringoceles are uncommon, usually described in children and most commonly limited to the ducts. We describe more complex variants in an adult population affecting with varying degrees of severity, the glands themselves, and the complications they may lead to. One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed. Twenty-six patients (mean age: 41.1 years) with Cowper's syringoceles who were managed between 2009 and 2016 were subsequently evaluated. Presentation, radiological appearance, treatment (when indicated), and outcomes were assessed. Of 100 urethrograms in patients with strictures, 33.0% demonstrated filling of Cowper's ducts or glands, occurring predominantly in patients with bulbar strictures. Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland. Of 26 symptomatic patients, 15 presented with poor flow. In four patients, a grossly dilated Cowper's duct obstructed the urethra. In the remaining 11 patients, a bulbar stricture caused the symptoms and the syringocele was identified incidentally. Eight patients presented with perineal pain. In six of them, fluoroscopy and magnetic resonance imaging (MRI) revealed complex multicystic lesions within the bulbourethral glands. Four patients developed perineoscrotal abscesses. In the 11 patients with strictures, the syringocele was no longer visible after urethroplasty. In three of four patients with urethral obstruction secondary to a dilated Cowper's duct, this resolved after transperineal excision (n = 2) and endoscopic deroofing (n = 1). Five of six patients with complex syringoceles involving Cowper's glands were excised surgically with symptomatic relief in all. In conclusion, Cowper's syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.

Mecanismos fisiopatológicos da dor pélvicana endometriose profunda: [revisão] / Pathophysiological mechanisms of pain endometriosis pélvicana: [review]

Endometriose é uma doença ginecológica crônica, benigna, estrogênio-dependente, multifatorial, sendo dor pélvicae a infertilidade os mais comuns dos sintomas. A endometriose profunda, definida pela lesão que se infiltra por mais de 5 mm no local de acometimento, é comumente associada com sintomas mais exuberantes, porém, a fisiopatologia da associação entre a dor e a doença é pouco conhecida. Acredita-se que a inflamação crônica seja a principal causa, sendo que fibras nervosas foram identificadas em endométrio tópico e em lesões ectópicas da doença, traçando um paralelo entre a densidade e a qualidade dessas fibras com a dor. A sintomatologia da endometriose, assim comoexames de imagem especializados, pode sugerir a doença, porém, o diagnóstico definitivo somente é realizado por meio de laparoscopia e biópsia de lesões suspeitas. As alterações do endométrio, além de proporem um mecanismo de dor específico, abrem nova perspectiva de diagnóstico menos invasivo da doença e de menor custo. Tendo em vista a importância do tema no contexto da prevalência da doença, dificuldade diagnóstica e atualidade da relação entre fibras nervosas e lesões de endometriose, foi proposta a presente revisão.

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature / Endometrioma de cicatriz após incisões cirúrgicas obstétricas: estudo retrospectivo de 33 casos e revisão da literatura

Context and objective: The incidence of scar endometrioma ranges from 0.03 to 3.5 percent. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed. Design and setting: Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. Methods: Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. Results: There were 33 patients, of mean age 30.1 ± 5.0 years (range: 18-41 years). The total incidence was 0.11 percent: 0.29 percent in cesarean sections and 0.01 percent in vaginal deliveries. Twenty-nine tumors (87.9 percent) were located in cesarean scars, two (6.0 percent) in episiotomy scars and two (6.0 percent) in the umbilical region. The main symptom was localized cyclical pain (66.7 percent), of mean duration 30.5 months (± 23). Surgical treatment was successful in all cases. Conclusion: This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01). The surgical treatment of choice is excision of the endometrioma with a safety margin.

Contexto e objetivo: A incidência de endometrioma de cicatriz varia de 0,03 a 3,5 por cento. Alguns fatores relacionados ao conhecimento da história clínica da doença dificultam o diagnóstico e o tratamento corretos. O objetivo é traçar o padrão clínico da doença e avaliar resultados cirúrgicos. Foi revisada a literatura sobre o assunto. Tipo de estudo e local: Estudo descritivo e retrospectivo realizado no Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. Métodos: Foi realizado levantamento e revisão de dados dos prontuários médicos das pacientes com diagnóstico pré-operatório de endometrioma de cicatriz, operadas entre 2001 e 2007. O diagnóstico pós-operatório foi feito por exame histopatológico. As principais informações levantadas foram: idade, antecedentes obstétricos, sintomatologia, localização, tamanho e palpação do tumor, duração da queixa, diagnóstico, tratamento. Todas as pacientes foram submetidas a exerese da massa tumoral com margem de segurança. Resultados: Foram encontrados 33 pacientes com média de idade 30,1 (± 5,0), variando de 18 a 41 anos. A incidência total foi de 0,11 por cento, nas cesarianas foi de 0,29 por cento e nos partos vaginais, 0,01 por cento. Localização do tumor: 29 casos em cicatriz de cesária (87,9 por cento), dois em região umbilical (6,0 por cento) e dois em cicatriz de episiotomia (6,0 por cento). A principal sintomatologia foi dor cíclica localizada (66,7 por cento), com duração média de 30,5 meses (± 23). O tratamento cirúrgico foi realizado com sucesso em todas as pacientes. Conclusão: Trata-se de uma doença incomum. O dado de maior importância diagnóstica foi: coincidência da sintomatologia dolorosa com a menstruação. Pacientes submetidas a cesariana têm maior risco (risco relativo = 27,37 e P < 0,01). O tratamento cirúrgico de escolha é exerese do endometrioma com margem de segurança.

Utilización de la resonancia magnética con contraste de fase para el diagnóstico del síndrome de congestión pelviana / Using phase contrast MRA for the diagnosis of pelvic congestion syndrome

Introduction: Pelvic congestion syndrome (PCS) is produced by anomalous flow in ovarían veins. Direct venography (DV) is the gold-standard for diagnosis. Phase-Contrast Magnetic Resonance Angiography (PC-MRA) appears as an alternative that would permit a morphological and functional assessment. The purpose of the study was to evaluate the usefulness of flow velocity (measured with PC-MRA) as a diagnostic criterion and also to compare it with the DV technique. Patients and methods: We prospectively included 8 female patients with clinical suspicion of PCS who were referred for undergoing DV over a six-month period. PC-MRA examinations were performed in all of them. Slow anterograde or retrograde flow were the diagnostic criteria. Sensitivity, specificity, PPV, and NPV were also calculated. Results: Data from 16 veins were analized by means of a home-made software written in Matlab. There were 12 abnormal and 4 normal veins according to DV results. All the abnormal veins were correctly identified by MR-PC. Two veins (corresponding to the same patient) were considered as normal in accordance with DV results, whereas the PC-MRA analysis revealed them as abnormal veins. This patient presented with PCS typical symptoms. Sensitivity and specificity values were 100 and 50 percent, respectively, whereas PPV and NPV values were 86 and 100 percent, respectively. Conclusion: PC-MRA is a useful diagnostic tool for patients with clinical suspicion of PCS and could avoid unnecessary invasive procedures.

Introducción: El síndrome de congestión pelviana (SCP) es producido por flujo anómalo en las venas ováricas. La venografía directa (VD) es el estándar de referencia. La resonancia magnética con contraste de fase (MR-CF) permitiría una evaluación morfológica y funcional. El propósito fue evaluar la utilidad de la velocidad de flujo medida con RM-CF como criterio diagnóstico comparado con VD. Pacientes y Métodos: Incluimos prospectivamente 8 pacientes derivadas para VD por sospecha de SCP durante 6 meses; todas fueron sometidas a RM-CF. Los criterios diagnósticos fueron: flujo retrógrado o anterógrado lento. Se calculó sensibilidad, especificidad, VPP y VPN. Resultados: Analizamos los datos de 16 venas, utilizando un software propietario escrito en Matlab. Hubo 12 venas anormales y 4 venas normales en VD. Todas la venas anormales fueron correctamente identificadas por MR-PC. Dos venas (la misma paciente) fueron normales en VD y anormales en MR-PC. Esta paciente tenía clásicos síntomas de SCP La sensibilidad fue de 100 por ciento, especifidad de 50 por ciento, VPP de 86 por ciento y VPN de 100 por ciento Discusión: MR-PC es una herramienta útil en el diagnóstico del SCP y evitaría exámenes invasivos innecesarios.

Características epidemiológicas de pacientes atendidas en la consulta de endometriosis de un hospital universitario / Epidemiological characteristics of patients attended at the outpatient clinic of endometriosis in universitary hospital

Establecer las características epidemiológicas de pacientes con endometriosis. Es un trabajo descriptivo y transversal. La población fue de 54 pacientes. La recolección de la información mediante la revisión documental en una ficha. Consulta de endometriosis del Hospital Universitario Dr. Angel Larralde de Valencia. Edad promedio 30 ± 5,8 años. Motivos de consulta: dismenorrea (70,7 por ciento), dolor pélvico (58,5 por ciento) y dispareunia (36,6 por ciento). Edad promedio de menarquía 12 años. El 29 por ciento reportó algún tipo de trastorno menstrual, el más frecuente la metrorragia (17 por ciento). El 41,5 por ciento refirió uso previo de anticonceptivos orales. El 34 por ciento de las pacientes no habían estado embarazadas, 26,88 por ciento primigesta. Entre los antecedentes quirúrgicos gineco-obstétricos, 39 por ciento reportó cesáreas, 26,88 por ciento ooforectomía y 19,55 por ciento legrado uterino. Las endometriosis más frecuentes fueron la ovárica (56,09 por ciento) y en cicatriz abdominal postcesárea (24,39 por ciento). La endometriosis es una patología típica de la mujer en edad reproductiva, que puede darse inclusive en la adolescencia.

Accuracy of laparoscopy for assessing patients with endometriosis / Eficácia da videolaparoscopia na avaliação de mulheres com endometriose pélvica

CONTEXT AND OBJECTIVE: Diagnoses of endometriosis are based on observation of endometriotic lesions by means of laparoscopy, along with the pathological findings. The aim of this study was to evaluate the sensitivity and specificity of the macroscopic findings in relation to the histopathological findings. More specifically, we aimed to test the efficacy of laparoscopy alone for diagnosing endometriosis and to evaluate the laterality of endometriosis among the study population. DESIGN AND SETTING: Cross-sectional study on women undergoing laparoscopy due to pelvic pain or infertility, in the Gynecology Department of Hospital Santa Cruz in Curitiba, Paraná, Brazil, and Pontifícia Universidade Católica do Paraná. METHODS: A total of 976 patients underwent laparoscopy and biopsy due to pelvic pain and/or infertility. We analyzed the laparoscopic and histopathological findings from patients with pelvic endometriosis (n = 468) and patients without endometriosis (n = 508). RESULTS: In 468 (47.95 percent) of the cases, the clinical and laparoscopic findings were consistent with endometriosis, and this was confirmed histopathologically in 337 (34.5 percent). Among the remaining 508 patients, although the laparoscopy was performed for other reasons relating to acute pelvic pain, eight were diagnosed with endometriosis from histopathological examination of the pelvic specimens obtained. Therefore, endometriosis was confirmed in 345 patients (35.3 percent). In comparison with the histopathology, laparoscopy alone presented 97.68 percent sensitivity, 79.23 percent specificity, 72 percent positive predictive value and 98.42 percent negative predictive value. CONCLUSION: Laparoscopy should be used in conjunction with histopathology for diagnosing endometriosis.

CONTEXTO E OBJETIVO: O diagnóstico da endometriose é determinado pela visualização dos implantes à laparoscopia e pela comprovação histológica. O objetivo deste trabalho foi avaliar a sensibilidade e a especificidade dos achados macroscópicos cirúrgicos e histopatológicos. Avaliou-se a eficácia da laparoscopia isoladamente no diagnóstico da endometriose e a lateralidade da doença. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no Serviço de Ginecologia do Hospital Santa Cruz em Curitiba, Paraná e na Pontifícia Universidade Católica do Paraná. MÉTODOS: Foram avaliadas 976 pacientes submetidas à videolaparoscopia por dor pélvica ou infertilidade e a biópsia. Foram analisados os achados laparoscópicos e histológicos de 468 pacientes com endometriose pélvica e de 508 pacientes sem endometriose. RESULTADOS: Foram selecionadas 468 (47,95 por cento) pacientes para inclusão no presente estudo por apresentarem quadro clínico e videolaparoscópico de suspeita de endometriose. As 508 (52,04 por cento) pacientes restantes tiveram indicação da cirurgia por outras causas relacionadas à dor pélvica e oito tiveram o diagnóstico de endometriose pelo anatomopatológico. A endometriose foi confirmada em 345 pacientes (35,3 por cento). Ao compararmos a análise histológica com os achados a videolaparoscopia, observou-se sensibilidade de 97,68 por cento, especificidade de 79,23 por cento, valor preditivo positivo de 72 por cento, valor preditivo negativo de 98,42 por cento. CONCLUSÃO: Laparoscopia deve ser usada em conjunto com histopatologia para o diagnóstico de endometriose.

Dolor pélvico crónico e infertilidad como factores diagnósticos de endometriosis / Chronic pelvic pain and infertility as diagnostic factors of endometriosis

Determinar si los síntomas de dolor pélvico crónico y/o la infertelidad, son importantes en el diagnóstico precoz de endometriodid. Análisis retrospectivo de 100 pacientes con diagnóstico por laparoscopia de endometriosis, divididas en dos grupos: Grupo I constituido por 40 pacientes con el dolor pélvico crónico y el Grupo 2 con 60 pacientes con dolor pélvico e infertilidad, en el período enero 2002 a enero 2005. Hospital Coromoto, Maracaibo, Estado Zulia, Venezuela. El promedio de edad en la primera consulta fue de 26.5 y 34.6 años para los grupos 1 y 2 respectivamente. Se encontró un 74 por ciento de dispareunia profunda en ambos grupos. La sintomatología gastrointestinal en las pacientes del Grupo 1 se detectó en 28 por ciento y en las del Grupo 2 en el 38 por ciento, en distintos grados. El síndrome premenstrual y/o alteraciones emocionales, se presentaron en el 80 por ciento de las pacientes y el patrón también fue de moderado a severo. El estadio de la enfermedad valorado por laparoscopia, demostró que el nivel del dolor pélvico crónico no está relacionado con el de la enfermedad, pero sí con su ubicación anatómica, y la más dolorosa fue cuando se ubica en los ligamentos uterosacrales, y en el fondo de saco posterior. En las pacientes del Grupo 1 se presentó con mayor frecuencia el grado IV (12 por ciento), seguido del grado II (11 por ciento). En las pacientes del Grupo 2 los grados más frecuentes fueron el II (22 por ciento) y el I (18 por ciento). En las pacientes del Grupo 2 los grados más frecuentes fueron el II (22 por ciento) y el I (18 por ciento). En el 50 por ciento de las pacientes no se realizó estudio histopatológico. El dolor pélvico crónico es más frecuente en mujeres jóvenes que presentan endometriosis, mientras que la infertilidad se presenta con mayor frecuencia en el grupo de pacientes de mediana edad. Amedida que se avanza en edad, la probabilidad de encontrar infertilidad y dolor pélvico aumenta.

Pelvic pain and dispareunia: a benign cystic mesothelioma case report

Benign cystic mesothelioma is a rare tumor originated from mesenchymal cells of the abdominal and pelvic peritoneum. This rare tumor should be considered in the differential diagnosis of young women presenting with abdominal pain and a multicystic abdominal mass