Uso clínico do hormônio antimülleriano em ginecologia / Clinical use for anti-mullerian hormone in gynecology

O hormônio antimülleriano (AMH) é uma glicoproteína produzida pelas células granulosas de folículos ovarianos primários, pré-antrais e pequenos folículos antrais e ultimamente sua aplicabilidade clínica tem sido demonstrada através de diversos estudos. A predição da resposta à estimulação ovariana para fertilização in vitro corresponde a sua mais frequente utilização na prática clínica, sendo rotineiramente realizada em muitos serviços para identificar subgrupos de mulheres suscetíveis a má resposta ou a Síndrome da Hiperestimulação Ovariana. Existem perspectivas de que o AMH possa ser aplicável na individualização do risco de injúria gonadal iatrogênica em mulheres portadoras de neoplasia que serão submetidas a quimioterapia. Também é provável que as dosagens de AMH sejam incluídas nos protocolos de investigação de amenorreias e oligomenorreias, uma vez que seus níveis encontram-se elevados em pacientes portadoras da Síndrome dos Ovários Policísticos, reduzidos em casos de falência ovariana prematura e normais em outras condições como a hiperprolactinemia e o hipogonadismo hipogonadotrófico. É possível que futuramente o AMH venha a ser utilizado na predição da idade de menopausa e do prognóstico reprodutivo da mulher, fornecendo bases sólidas ao aconselhamento conceptivo e contraceptivo.

Anti-mullerian hormone (AMH) is a glycoprotein produced by granulosa cells of primary, pre-antral and small antral ovarian follicles and its clinical applicability has been recently demonstrated by several studies. Prediction of the response to ovarian stimulation for in vitro fertilization corresponds to the most frequent utilization of AMH in clinical practice, being routinely assessed in many services to identify subgroups of women susceptible to a poor response or to Ovarian Hyperstimulation Syndrome. There are great perspectives that AMH may be applicable to the individual determination of risk for iatrogenic gonadal injury in women with neoplasms who will be submitted to chemotherapy. It is also probable that AMH assessment will be included in protocols for the investigation of amenorrhea and oligomenorrhea, since AMH levels are increased in Polycystic Ovary Syndrome, reduced in premature ovarian failure and normal in other conditions such as hyperprolactinemia and hypogonadotropic hypogonadism. It is possible that AMH will be utilized in the future for the prediction of age at menopause and of reproductive prognosis, providing solid bases for pre-conceptive and contraceptive counseling.

Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients

OBJECTIVES: Under a constant inspired concentration, the uptake of a volatile anesthetic into the arterial blood should mainly be governed by alveolar ventilation, according to the assumption that the patient's cardiac output remains stable during anesthesia. We investigated whether ventilation volume affects the rate of desflurane uptake by examining arterial blood concentrations. METHOD: Thirty female patients were randomly allocated into the following three groups: hyperventilation, normal ventilation and hypoventilation. Hemodynamic variables were measured using a Finometer, inspiratory and end-tidal concentrations of desflurane were measured by infrared analysis, and the desflurane concentration in the arterial blood (Ades) was analyzed by gas chromatography. RESULTS: During the first 10 minutes after the administration of desflurane, the Ades was highest in the hyperventilation group, and this value was significantly different from those obtained for the normal and hypoventilation groups. In addition, hyperventilation significantly increased the slope of Ades-over-time during the first 5 minutes compared with patients experiencing normal ventilation and hypoventilation, but there were no differences in these slopes during the periods from 5-10, 10-20 and 20-40 minutes after the administration of desflurane. This finding indicates that there were no differences in desflurane uptake between the three groups after the first 5 minutes within desflurane administration. CONCLUSIONS: Hyperventilation accelerated the rate of the rise in Ades following desflurane administration, which was time-dependent with respect to different alveolar ventilations levels.

Aplicações das dosagens de inibinas em Ginecologia e Obstetrícia / Clinical usefulness of inhibin assays in Gynecology and Obstetrics

Na mulher, a principal fonte de inibina B são as células da granulosa de folículos em crescimento, enquanto a inibina A é secretada principalmente pelo corpo lúteo e pela placenta. Em mulheres inférteis submetidas a terapias de reprodução assistida, a inibina B se mostrou útil para predizer má resposta ovulatória, embora não tenha superado o desempenho de outros marcadores. No rastreamento pré-natal da síndrome de Down, a utilidade da inibina A foi repetidamente confirmada no segundo trimestre e começa a ser considerada também na bateria de testes do primeiro trimestre. Além das duas aplicações acima, a dosagem de inibina total pode contribuir para a identificação de casos de insuficiência ovariana autoimune. A inibina total também pode ser um marcador auxiliar no diagnóstico de tumores epiteliais do ovário, enquanto a dosagem de inibina B auxilia no diagnóstico de tumores de células da granulosa. O uso da inibina A pode se estender à avaliação de gestantes com ameaça de abortamento, com história de abortamento de repetição, com risco aumentado de pré-eclâmpsia, ou ainda nos primeiros dias de seguimento pós-esvaziamento de mola hidatiforme. Todas essas aplicações continuam em estudo, mas com possibilidade real de virem a ampliar o espectro diagnóstico das dosagens de inibinas em Ginecologia e Obstetrícia.

The main source of inhibin B in women is the growing follicle granulosa cells, while inhibin A is mainly produced by the corpus luteum and the placenta. In infertile women submitted to therapies of assisted reproduction, inhibin B has shown to be useful to predict a poor ovulatory response, though it has not yet overcome the performance of other markers. In the pre-natal screening of the Down syndrome, inhibin A has been repeatedly confirmed as useful in the second trimester and has also started to be considered in the first trimester test battery. Besides the two applications above, the dosage of total inhibin may contribute to the identification of cases of autoimmune ovarian insufficiency. Total inhibin may also be an auxiliary marker in the diagnosis of ovarian epithelial tumors, while the amount of inhibin B helps in the diagnosis of granulosa cells tumors. The use of inhibin A may be extended to the evaluation of pregnant women with risk of abortion, with a history of repeated abortion, with increased risk of pre-eclampsia, or even in the first days of follow-up of hydatiform mole post-emptying. All those applications are still under study, but with a real possibility of helping to extend the diagnostic spectrum of inhibin dosage in Gynecology and Obstetrics.

Diagnostic utility of serologic markers for genital chlamydial infection in STD patients in Chennai, India.

OBJECTIVES: To evaluate the diagnostic utility of serological markers for C. trachomatis in different clinical groups of STD patients. METHODS: Blood and genital swab specimens were collected from symptomatic STD patients (n=143) attending the STD out patient clinic at the Institute of STDs, Government General hospital, Chennai who enrolled for the study. Serological determination for IgM, IgA and IgG antibodies to C. trachomatis was done using commercial kits. PCR analysis was performed on genital swab samples by using plasmid and major outer membrane protein (MOMP) based primers and patients who were positive by both PCR assays were considered as proven cases of C. trachomatis infection. The serological marker positivity was analysed with PCR positivity. RESULTS: Serologic positivity by IgM, IgA and IgG was 22.4%, 28.7% and 58.7% respectively. The PCR analysis showed 44 (30.8%) cases with confirmed C. trachomatis infection. Seropositivity for IgM (34.1% (15/44) vs. 17.2% (17/99); P<0.05) as well as for IgA (40.9% (18/44) vs. 23.2% (23/99); P<0.05) significantly correlated to PCR positivity, while significant correlation was not seen with IgG positivity. The overall seropositivity (IgM/IgA/IgG) in the study population was 68.5%. CONCLUSIONS: The observations of the present study indicate a high exposure rate to chlamydial infection in STD clinic patients in India. The study also suggests the usefulness of serology instead of PCR to trace chlamydial etiology, especially in deep-seated upper genital tract diseases and to facilitate better clinical management as there was good correlation between serology and PCR positivity.

Preoperative autologous blood collection and haemodilution with gelatin solution (gelifundol).

Autologous blood collection and haemodilution with gelatin solution had an effect on the decrease in red blood cells, haemoglobin, haemotocrit, fibrinogen and platelets; however, this technique had no effect on coagulograms, platelet function and haemostasis. In conclusion, this technique is suitable and possibly practical in obtaining sufficient blood for elective surgical patients and is without any undesirable side effects.

Serum fucose levels in gynaecological disorders including carcinoma cervix.

Serum protein bound fucose levels and the ratio between serum protein bound fucose and total serum protein were determined in 40 healthy females, 60 patients with benign gynaecological disorders and 50 patients with previously untreated cases of carcinoma cervix. The mean serum fucose level in healthy subjects was 8.96 mg% and the ratio between serum protein bound fucose and total serum protein was 1.29 x 10(-3). Mean serum fucose level in patients with benign gynaecological disorders was 9.42 mg% and the ratio between serum protein bound fucose and total serum protein was 1.42 x 10(-3). In stage I and II carcinoma cervix patients mean serum fucose was 11.92 mg% and the ratio between serum protein bound fucose and total serum protein was 1.68 x 10(-3). In stage III and IV carcinoma cervix patients the mean serum fucose was 17.76 mg% and the ratio between serum protein bound fucose and total serum protein was 2.64 x 10(-3).