Maternal weight variation in different intrauterine environments: an important role of hypertension / Variação de peso materno em diferentes ambientes intrauterinos: um papel importante da hipertensão

Abstract Objective Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM). Methods It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016.Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed. Results A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6th month postpartum (the difference between the maternal weight at 6months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ~ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg. Conclusion This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age.

Resumo Objetivo Diferentes ambientes intrauterinos podem influenciar a variação de peso corporal pré-gestacional materno até 6 meses pós-parto. O objetivo do presente estudo foi verificar a associação de fatores sociodemográficos, obstétricos, nutricionais e comportamentais com a variação de peso em mulheres divididas em quatro grupos: hipertensas (HM), diabéticas (DM), tabagistas (SM) e controles (CM). Métodos Amostra de conveniência de 124 puérperas recrutadas em 3 hospitais públicos da cidade de Porto Alegre, Rio Grande do Sul, Brasil, entre 2011 e 2016. Regressões lineares múltiplas e modelos de equações de estimativas generalizadas (GEE) foram realizados para identificar os fatores associados à variação do peso materno. Para todas as GEE, as medidas de peso materno foram ajustadas para a estatura materna, paridade, escolaridade e tipo de parto, e três medidas de peso (prégravidez, anterior ao parto e 15 dias pós-parto) foram fixadas. Resultados Um modelo hierárquico associou o diagnóstico materno de hipertensão e o índice de massa corporal (IMC) pré-gestacional de sobrepeso com ganho de peso materno medido até o 6° mês pós-parto (diferença entre o peso materno aos 6 meses pós-parto e o peso pré-gestacional). Estes resultados mostraram que o grupo HM e mulheres comsobrepeso aumentaram o peso corporal em ~ 5,2 kg 6 meses pós-parto, em comparação com os demais grupos. Além disso, as mulheres classificadas com sobrepeso tiveram uma variação maior de peso corporal, de 3,150 kg. Conclusão Evidenciou-se a necessidade de diretrizes nutricionais específicas para distúrbios hipertensivos gestacionais, bem como de maior atenção dos serviços de saúde públicos para mulheres com excesso de peso em idade fértil.

Pregnancy of unknown location: the value of frozen section analysis and its relation to Beta-hCG levels and endometrial thickness

Abstract Objective Frozen section examination is a rapid method for identifying products of conception in endometrial curetting, yet its accuracy is inconclusive. The purposes of this study is to determine the accuracy of frozen section analysis of endometrial curetting in pregnancies of unknown location, and to verify the relation of β-human chorionic gonadotrophin (hCG) level and endometrial thickness to the assessed accuracy. Methods We reviewed data from January 2009 to December 2014 of diagnostic curettages from women with suspected ectopic pregnancies sent for frozen section examination at a medical center. A frozen section diagnosis was considered accurate if it concurred with the final pathologic diagnosis. Results Of 106 frozen section studies, the diagnosis was accurate in 94 (88.7%). Of 79 specimens interpreted as negative on frozen sections (no products of conception noted), 9 (11.4%) were positive on final pathologic review. Three of the 27 (11.1%) specimens interpreted as positive by a frozen section failed to demonstrate products of conception on a final pathologic section. The sensitivity of frozen sections in the diagnosis of ectopic pregnancy was 72.7%, specificity 95.9%, positive predictive value 88.9%, negative predictive value 88.6%, and accuracy 88.6%. A statically significant correlation was found between β-hCG level and high accuracy of the frozen section technique (p< 0.001). No correlation was found between endometrial thickness and the accuracy of the frozen section technique. Conclusion The accuracy of frozen section examination was high and was found to correlate with β-hCG level, but not with endometrial thickness.

Recurso morfométrico para el diagnóstico de hiperplasia endometrial compleja y adenocarcinoma endometrioide. Matanzas 2014-2015 / Morphometric resource for the diagnosis of complex endometrial hyperplasia, and endometrial adenocarcinoma. Matanzas 2014-2015

Introducción: el endometrio es fundamental para el diagnóstico de entidades que constituyen problemas de salud para la población femenina. Resulta de vital importancia para el patólogo el hallazgo de diferencias entre la morfología del endometrio de la hiperplasia endometrial y el adenocarcinoma endometrioide que le permitan realizar el diagnóstico diferencial ente estas dos entidades. Objetivo: determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal. Materiales y métodos: se realizó un estudio observacional descriptivo de corte transversal y se aplicó morfometría a una muestra de 30 biopsias endometriales, con el objetivo de determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal. Se utilizó sistema morfométrico IMAGEN J 1.44p, se estudiaron las glándulas endometriales a las que se les halló la altura del epitelio glandular. Resultados: la altura del epitelio en las glándulas de tamaño menor, intermedio y mayor, expresaron estrechas diferencias entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal y que existen diferencias entre la hiperplasia endometrial y el adenocarcinoma endometrioide cuando se estudian variables que tiene en cuenta la morfología glandular. Conclusiones: se concluyó que existen diferencias entre la hiperplasia endometrial y el adenocarcinoma endometrioide cuando se estudian variables que tiene en cuenta la morfología glandular (AU).

Introduction: the endometrium is fundamental for the diagnosis of entities that are a health problem for female population. It is very important for the pathologist to find differences between the morphology of the endometrium of the endometrial hyperplasia and the endometrial adenocarcinoma allowing to perform the differential diagnosis between these two entities. Objective: to determine the morphometric differences for the differential histopathological diagnosis between the complex endometrial hyperplasia, the endometrial adenocarcinoma and the normal proliferative endometrium. Materials and methods: a cross-sectional, descriptive, observational study was applied and the morphometry was applied to a sample of 30 endometrial biopsies, with the objective of determining the morphometric differences for the histopathological differential diagnosis among complex endometrial hyperplasia, endometrial adenocarcinoma and normal proliferative endometrium. The morphometric system IMAGEN J 1.44p was used and the endometrial glands were studied and the height of their glandular epithelium was calculated. Results: the minor, intermediate and higher height of the epithelium in the glands expressed tight differences among complex endometrial hyperplasia, endometrial adenocarcinoma and normal proliferative endometrium, and showed that there are differences between endometrial hyperplasia and endometrial adenocarcinoma when the studied variables take into account the glandular morphology. Conclusions: there are differences between endometrial hyperplasia and endometrial adenocarcinoma when there are studied variables taking into account the glandular morphology (AU).

A Study of Endometrial Pathology by Transvaginal Color Doppler Ultrasonography and its Correlation with Histopathology in Post-menopausal Women.

Objective: Endometrial carcinoma is the most common gynaecological malignancy. Approximately 80% of endomentrial carcinoma occur in post-menopausal women. Present study aimed to evaluate the role of transvaginal ultrasonography and colour flow imaging in diagnosing endometrial pathologies especially endometrial carcinoma and later its confirmation by histopathology. Methods: 38 women presenting with history of at least 6 months amenorrhoea followed by bleeding per vaginum were included in the study. Transvaginal colour Doppler (TVS) followed by fractional curettage was done in all cases and cervical biopsy was done in selected cases. Uterine size, endometrial thickness and blood flow indices (RI, PI) were measured. Analysis of data was done using ‘z’ test and ‘t’ test. Results: Out of 38 women maximum number of cases (39.47%) were between 50 – 55 years. Using 4 mm of endometrial thickness as cut off value for discriminating normal and abnormal endometrium, sensitivity, specificity, PPV and NPV were 94.12%, 50%, 95.12% and 50% respectively (p < 0.05). No case of endometrial carcinoma was detected when the endometrium was <4 mm, making the sensitivity as 100%, NPV 100%, specificity 13.33% and PPV 23.53%. Using RI = 0.81 as cut off value for discriminating benign and malignant endometrium, sensitivity was 62.5%, specificity 53.33%, PPV – 26.3% and NPV as 84.2%. Conclusion: Transvaginal sonographic (TVS) evaluation of endometrial thickness (ET) is a reliable method of screening women with post-menopausal bleeding. Conservative approach may be offered to women showing ET of less than 4 mm and high impedance to flow in uterine and endometrial vessels.

Detección inmunohistoquímica del receptor de estrógeno en el endometrio de ovejas de alta prolificidad y de prolificidad estándar / Immunohistochemical detection of estrogen receptor in the endometrium of sheep high prolificacy and standard prolificacy

Uno de los factores que incide en la capacidad reproductiva de los ovinos es la presencia de receptores de estrógeno en el tracto genital, donde regulan la expresión de numerosos genes comprometidos en su desarrollo morfológico y funcional. Posiblemente el desempeño reproductivo de diferentes razas de ovejas podría estar determinado por la expresión diferencial de estos receptores. En el presente estudio, se evaluó comparativamente el nivel de expresión del receptor de estrógeno en tejido endometrial de ovejas prepúberes de alta prolificidad (raza Texel) y de prolificidad estándar (raza Araucana) mediante análisis inmunohistoquímico. Se concluye que el nivel de expresión del receptor de estrógeno en tejido estromal, epitelial, de revestimiento y glandular del endometrio de ovejas de raza Texel es significativamente mayor que en ovejas de raza Araucana. Esta diferencia en el nivel de expresión de estos receptores podría estar relacionado con la diferencia de prolificidad entre estas razas...

A factor that affects the reproductive capacity of sheep is the presence of estrogen receptors in the genital tract, where they regulate the expression of numerous genes involved in morphological and functional development. Possibly the reproductive performance of different breeds of sheep could be determined by the differential expression of these receptors. In the present study, we evaluated comparatively level of estrogen receptor expression in endometrial tissue ewe lambs high prolificacy (Texel) and standard prolificacy (Araucana) by immunohistochemical analysis. It is concluded that the level of estrogen receptor expression in stromal tissue, epithelial lining and endometrial glandular Texel Sheep is of greater intensity than in ewes Araucana, this difference in the expression level of these receptors could be related to the increased prolificacy of Texel breed...

Avaliação histomorfométrica do endométrio na fase lútea de mulheres férteis e inférteis / Evaluation the endometrial histomorphometry of fertile and infertile women during their luteal period

OBJETIVO: avaliar a histomorfometria do endométrio na fase lútea de mulheres férteis e inférteis. MÉTODOS: foram triadas 40 pacientes, 30 inférteis e 10 férteis, em seguimento na Clínica Ginecológica do HC-FMUSP, que concordaram em participar deste estudo. Foi realizada avaliação ultrassonográfica seriada a partir da menstruação, para determinação da ovulação. Na fase lútea as pacientes eram submetidas à histeroscopia. Foram excluídas 14 pacientes sendo 12 por falta durante a avaliação ultrassonográfica e 2 pela presença de pólipos. A casuística foi composta por 6 controles férteis, que foram comparadas a 20 casos inférteis (endometriose-8, causa tubo-peritoneal-5, causa masculina-5, sem causa aparente-2). Na histeroscopia foram coletadas duas biópsias dirigidas (sistema de Bettocchi) da parede posterior (terço distal), e da parede anterior (terço médio), e uma biópsia aspirativa com Pipelle. Foram avaliados parâmetros histomorfométricos endometriais. RESULTADOS: as duas formas de biópsia foram apropriadas para análise endometrial; a dirigida coletou menor área tecidual, porém sem sangue. Nenhum paciente fértil apresentou heterogeneidade endometrial (atraso de fase em algum sítio); isto ocorreu em 7 (35%) das inférteis (p=0,11). Foi diagnosticada endometrite em 2 (10%) casos. CONCLUSÃO: não foram observadas diferenças histomorfométricas entre o endométrio de mulheres férteis e inférteis na fase lútea. Parte das pacientes inférteis mostrou heterogeneidade endometrial e endometrite. A biópsia dirigida, assim como a aspirativa, foi adequada ao estudo endometrial na fase lútea.

Objective: to evaluate the endometrial histomorphometry of fertile and infertile women during their luteal period. Methods: 40 female patients- 30 infertile and 10 fertile- who were being followed-up at the Gynecological Clinic at the Hospital das Clinicas (HC),-Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), agreed to participate in the study. Serial ultra sonograms, starting from their menstrual period, were performed to identify their ovulation. In the luteal phase the patients underwent hysteroscopy. From the initial sample, 14 patients were excluded from the study, 12 of whom for being absent during scheduled ultra sonograms and 2 for presenting polyps. The final sample thus consisted of 6 fertile females (control subjects) who were compared to 20 patients with infertility, categorized as follows: 8 due to endometriosis, 5 due to peritoneal tube conditions, 5 due to male infertility, and 2 with no apparent cause. During the hysteroscopy 2 directed biopsies (Bettocchis System) of the posterior wall (distal third section) and of the anterior wall (medial third) were performed, as well as Pipelle sampling. Endometrial histomorpholometric parameters were evaluated. Results: the two forms of endometrial sampling performed were appropriate for the endometrial analysis. The directed biopsy collected tissue from a smaller area, but it had no blood. None of the fertile patients presented endometrial heterogeneity, i.e., phase delay in any site. In contrast, this occurred in 7(35%) of the infertile females (p=0.11). Endometritis was diagnosed in 2 (10%) of the cases. Conclusions: no histomorphometric differences were observed in the endometrium of the fertile and infertile female patients during their luteal phase. About a third of infertile cases (35%) displayed endometrial heterogeneity and a small percentage of which (10%) had endometritis. Both the directed biopsy and Pipelle sampling were found satisfactory for studies of endometrium during the...

Histochemical study of early embryo implantation in rats / Estudio histoquímico de la implantación temprana en ratas

Embryo implantation is the process that results in attachment of the conceptus to the uterine wall. In this histochemical study, we investigated the early stage of embryo implantation in rats by morphological analysis and by the detection of total proteins and glycosaminoglycans using hematoxylin-eosin, toluidine blue at pH 4.0 (TB), and Xylidine Ponceau at pH 2.5 (XP). In non-pregnant females, the uterine layers could be clearly distinguished and showed the normal histology of the organ. In pregnant females, an increase in the number of cells and a reduction in the interstitial space were observed in the endometrium close to the implantation sites. The blastocyst was partially inserted in the endometrium, with the observation of the inner cells mass around the blastocyst cavity surrounded by trophoblastic cells. TB staining revealed mild metachromatic basophilia, which was more evident in the endometrial stroma around the implantation site. Histochemical staining with XP was also more intense in the stroma close to the site of implantation. On the other hand, histochemical staining with either TB or XP was more discrete at sites distant from the conceptus. This study demonstrated changes in the endometrial stroma in areas adjacent to the site of embryo implantation, with variations in glycosaminoglycans and proteins as demonstrated by the detection of anionic and cationic radicals, respectively.

La implantación embrionaria es el proceso que resulta en la unión del embrión a la pared uterina. En este estudio histoquímico, se determinó la fase inicial de implantación del embrión en ratas mediante el análisis morfológico y por la detección de proteínas totales y glicosaminoglicanos con hematoxilina-eosina, azul de toluidina a pH 4,0 (TB) y xilidina Ponceau a un pH de 2,5 (XP). En las hembras no preñadadas, las capas del útero pueden ser claramente distinguidas y mostraron la histología normal del órgano. En las hembras preñadas, se observa un incremento en el número de células y una reducción en el espacio intersticial del endometrio para cerrar los sitios de implantación. El blastocisto se implanta parcialmente en el endometrio, con presencia de masa de células internas en torno a la cavidad del blastocisto, rodeado por las células trofoblásticas. La tinción TB reveló leve basofilia metacromática, lo cual fue más evidente en el estroma endometrial alrededor del sitio de implantación. Tinción histoquímica con XP también fue más intensa próximo del estroma en el sitio de implantación. Por otro lado, la tinción histoquímica, ya sea con la tuberculosis o XP fue más leve en los lugares distantes del embrión. Este estudio demostró cambios en el estroma del endometrio en las zonas adyacentes al sitio de la implantación del embrión, con variaciones en glucosaminoglicanos y proteínas, como lo demuestra la detección de radicales aniónicos y catiónicos, respectivamente.

Expressão de MMP-2 e MMP-9 no endométrio de éguas saudáveis e portadoras de endometrite crônica / Expression of MMP-2 and MMP-9 in helth endometrium and in chronic endometritis of mares

Avaliaram-se, por método imunoistoquímico, a expressão e distribuição das metaloproteinases (MMP) 2 e 9 em amostras de endométrio hígido e de éguas portadoras de endometrite crônica. Foram utilizadas 60 biópsias endometriais. A MMP-2 foi observada na parede vascular, nas células estromais e no epitélio glandular, e a imunorreatividade mais intensa foi obtida nas células do epitélio glandular nas endometrites da categoria III e na parede vascular nos endométrios da categoria I. A marcação imunoistoquímica para MMP-9 mostrou-se difusa pelo endométrio e foi observada no epitélio luminal e glandular, na região da parede vascular, nas células estromais, endoteliais e do infiltrado inflamatório. Houve diminuição da marcação imunoistoquímica na região da parede vascular conforme aumentou o grau das lesões endometriais concomitante à diminuição da intensidade da reação. Não houve relação na expressão imunoistoquímica das metaloproteinases estudadas com o tipo de endometrite.

The expression and distribution of matrix metalloproteinases (MMP) 2 and 9 were evaluated in helth endometrium and in chronic endometrites of mares by means of immunohistochemistry method. Sixty endometrial biopsies were utilized. Expression of MMP-2 was observed in vascular wall, stromal cells, and glandular epithelium. More intense immune reaction was seen in glandular epithelial cells in category III endometritis and in vascular wall in category I endometrium. MMP-9 immune reaction was diffuse and was seen in luminal and glandular epithelium; vascular wall region; and stromal, endotelial, and inflammatory cells. There was a decreased of the immunohistochemical marking in vascular wall region as increased the degree of endometrial injury, as well as reducing the intensity of reaction in this compartment. There was no relation in immunohistochemistry expression of metalloproteinases with the type of endometritis.

Histologia e morfometria em cornos uterinos de cadelas nulíparas, multíparas e tratadas com contraceptivos / Histology and morphometry in uterus horns of nulliparous bitches, multiparous ones and bitches treated with contraceptives

Dados histológicos e morfométricos foram obtidos de útero de cadelas nulíparas (n=6), multíparas (n=6) e de cadelas tratadas com contraceptivo (n=6). Para esse fim foram usadas seis amostras de cornos uterinos, em corte médio, para cada grupo. As mensurações das espessuras da parede uterina, endométrio total, miométrio total, miométrio interno, miométrio externo, estrato vascular e diâmetro das glândulas endometriais normais não foram estatisticamente significantes entre as cadelas multíparas e tratadas, com exceção para a altura do epitélio de glândulas normais. As mensurações das espessuras da parede uterina, endométrio total, miométrio total, miométrio interno, diâmetro das glândulas normais e altura do epitélio glandular foram significantes, comparando cadelas nulíparas com as multíparas e/ou tratadas, com exceção para as espessuras do miométrio externo e estrato vascular. Diante dos resultados obtidos, pode-se concluir que os dados numéricos confirmam que (1) o uso de anticoncepcionais e sucessivas gestações afetam a estrutura uterina em seu total; (2) o miométrio externo e estrato vascular foram as regiões que menos sofreram alterações comparando-se os 3 grupos; (3) as variações morfológicas ocorreram com a mesma intensidade no endométrio e miométrio totais para as cadelas tratadas e multíparas, e (4) a presença de glândulas endometriais dilatadas foi o diferencial encontrado nas cadelas tratadas, pois as mesmas estavam ausentes nas multíparas e nulíparas.

Histological and morphometric data were obtained from uterus of nulliparous bitches (n=6), multiparous ones (n=6), and bitches treated with contraceptive (n=6). Six samples of uterine horns, cut in average for each group. Measurements of the thickness of the uterine wall, total endometrium, total myometrium, internal myometrium, external myometrium, vascular layer and diameter of normal endometrial glands were not statistically significant between the treated and multiparous bitches, except for the height of the epithelium of normal glands. Measurements of thickness of the uterine wall, total endometrium, total myometrium, myometrium internal diameter and height of the glands of normal glandular epithelium were significant, comparing nulliparous with multiparous bitches and/or treated, except for thickness of the myometrium and vascular outer layer. It can be concluded that (1) the use of contraceptives and successive pregnancies affected uterine structures in its full, (2) the vascular layer and external myometrium were the regions with less variation, (3) morphological changes occurred with the same intensity in the total endometrium and myometrium of treated and multiparous bitches; and (4) the presence of dilated endometrial glands was the difference found in the treated bitches, because they were absent in nulliparous and multiparous ones.

Anticonceptivos hormonales y endometrio / Hormonal contraceptives and endometrial

La mujer por naturaleza, ha desarrollado fisiológicamente limitaciones en la fertilidad. Lo anterior se demuestra por la cantidad de días fértiles, como consecuencia de la ovulación, proceso que va desde la menarca hasta la menopausia, así como el período de lactancia, la infertilidad de la pareja etc; sin embargo debemos reconocer que las técnicas como el uso de hierbas, soluciones con fines contraceptivos u objetos aplicados por diferentes vías han sido utilizados por diferentes culturas alrededor del mundo.

O tratamento com isoflavonas mimetiza a ação do estradiol no acúmulo de gordura em ratas ovariectomizadas / Treatment with isoflavones replaces estradiol effect on the tissue fat accumulation from ovariectomized rats

OBJETIVO: As isoflavonas (ISO) presentes na soja são consideradas fitoestrógenos. A administração de fitoestrógenos tem efeito benéfico nos distúrbios da pós-menopausa que são caracterizados pela suspensão da função ovariana com declínio da secreção de estrogênio e conseqüentes desajustes histomorfológicos e metabólicos. O objetivo do presente estudo foi investigar o efeito da suplementação com ISO sobre a espessura do endométrio uterino, o acúmulo de gordura tecidual, o colesterol HDL e a glicose plasmática de ratas ovariectomizadas (OVX). MÉTODOS: Ratas Wistar com 60 dias de vida sofreram cirurgia bilateral para retirada dos ovários. Após o período de 8 dias de recuperação foram divididas em três grupos: falso operada (GC), OVX não-tratadas com ISO (GI) e as OVX suplementadas com ISO (GII). Foram retirados e pesados o útero, as gorduras uterinas e retroperitoneais. Também foram coletadas amostras de sangue para dosagem da concentração de HDL e glicose. RESULTADOS: A OVX promoveu atrofia do endométrio, diminuição do peso do útero e diminuição do HDL. O tratamento com ISO promoveu diminuição dos estoques de gorduras uterina e retroperitoneal, aumento de HDL e redução da glicemia, porém não teve efeito uterotrófico. CONCLUSÕES: Os dados do presente estudo mostram que o tratamento com ISO promove redução da adiposidade, o que pode estar relacionado à redução da lipogênese e ao aumento da lipólise.

OBJECTIVE: Isoflavones (ISO) present in soybean are named phytoestrogens because they show estrogen effect. The use of isoflavones has beneficial effect in disturbance of post-menopause, which is characterized by ovarian function suppression. Decreasing of estrogen secretion and consequent morphologic and metabolic disarrangements are observed in female hormonal decline. The aim of present work was to investigate the effect of ISO on the fat accretion of uterin endometric tissue, and HDL and glucose blood concentration from ovariectomized rats (OVX). METHODS: Female Wistar rats with 60 days-old were submitted a surgery to remove bilaterally the ovarium. After 8-day recovery period the animals were distributed into three groups: sham operate (GC); OVX ISO untreated (GI) and OVX supplemented with ISO (G II). Total uterus mass, uterus fat and retroperitoneal fat pad, were removed, washed and weighted. Samples of uterus were histological processed to measure endometrium thickness. Blood samples were also collected to analyze the concentration of HDL and glucose. The OVX caused endometric atrophy, decrease of uterus weight and HDL reduction. The treatment with ISO provoked decrease of uterin and retroperitoneal fat pad. HDL increase and glycemia reduction were also observed. However, there was no uterotrophic effect. CONCLUSIONS: ISO treatment causes decrease in tissue fat accretion from ovariectomized rats.

Morphometric evaluation of endometrial blood vessels.

Five hundred endometrial specimens were studied to document the changes in blood vessels in various phases of menstrual cycle, menstrual disturbances and in unexplained infertility. Sixty-three cases were taken as control and 437 cases as study group which included cases of dysfunctional uterine bleeding (DUB), endometrial polyps, fibroids, adenomyosis, infertility and atrophic endometrium. Using light microscopy, the vascular morphology was studied. The blood vessels were concentrated more in basal layer in the proliferative phase and in functional layer in the secretory phase. Cases of complex hyperplasia and pill endometrium had significantly higher vessel concentration. Congestion and dilatation of blood vessels were significantly higher in cases of DUB. The present study showed a positive correlation between endometrial angiogenesis and menstrual disorders. The alteration in blood vessel morphology has significant role in prognosis and in various anti-angiogenic therapies.

Estudio histomorfológico comparativo del endometrio de ovejas prepúberes de razas de distinta prolificidad / Comparative histomorphological study of prepuberal ewe endometrio of different prolificity races

El objetivo del presente estudio fue sentar bases morfológicas para realizar análisis inmunocitoquímicos e hibridación in situ de la presencia y distribución de receptores de estrógeno y progesterona en ovejas de distinta prolificidad y en distintos planos de nutrición, centrando nuestro interés en el endometrio por su relevancia en los mecanismos reproductivos. Se utilizaron ovejas prepúberes Romney Mash de alta prolificidad (n=2) y Araucanas de prolificidad standard(n=2) de las cuales inmediatamente después del sacrificio se tomaron muestras para estudio histológico del útero, oviducto y ovario. Para el análisis histológico los cortes fueron teñidos con Hematoxilina-Eosina, Van Giesson, Arteta y Ácido Periódico de Schiff (P.A.S.). Los resultados mostraron en las dos razas adecuado desarrollo endometrial, con ßreas carunculares e intercarunculares glandulares bien desarrolladas indispensables estas últimas para una buena implantación y crecimiento del embrión. Las glándulas, numerosas, eran tubulares, tortuosas, algo ramificadas y se extendían hasta el miometrio. No se observaron diferencias histológicas significativas entre ambas razas ni cambios morfológicos durante el transcurso de los días 93 al día 117 post natal, siendo su aspecto similar al de endometrio de la oveja adulta.

The aim of the present study was to sit morphological bases for the inmumocitochemical and hybridazion in situ study of the presence and distribution of estrogen and progesterone receptors in sheep of different prolificity and in different nutrition plane, centering our interest in the endometrium for its relevance in the reproductive mechanisms. We used sheep prepuberal Romney Mash of high prolificity (n=2) and Araucanian of standard prolificity(n=2) Immediately after slaughter uterine tissue was taken for histhological study from uteri , oviduct and ovary. Cross sections were stained with Hematoxilina-eosina, Van Giesson, Arteta and Periodic Acid of Schiff (P.A.S.). The results showed in both races a good endometrial development, with caruncular and glandular intercaruncular glandular areas well defined, the later necessary for embryo implantation and growth the numerous, tubular, coiled, glands, extend to the miometrium. No significant histological differences were observed between both races neither morphological changes between days 93 to 117 of post natal life, being their aspect similar to the endometrium of mature sheep

Estudo comparativo de éguas repetidoras ou não de cio através da avaliação histológica do endométrio e das concentrações plasmáticas de progesterona / Comparative study of repeat breeds and healthy mares through endometrial histology and plasmatic progesterone concentrations

O trabalho teve como objetivo geral fazer um estudo comparativo da histologia endometrial e das concentrações plasmáticas de progesterona (P4) em éguas, repetidoras ou não de cio. A hipótese do presente estudo é que existe correlação entre o histórico de infertilidade, os achados histopatológicos e a concentração de P4 destes animais. Para tanto, foram utilizadas 36 éguas, em idade reprodutiva (3-23 anos), das raças Mangalarga Marchador e Campolina. Utilizaram-se éguas não repetidoras (n=11) como grupo controle, sendo 4 éguas doadoras e 7 receptoras; e repetidoras de cio (n=25), 15 doadoras e 10 receptoras. Tal classificação foi realizada de acordo com o histórico reprodutivo destes animais. Amostras de endométrio foram coletadas para a realização de avaliação histopatológica e amostras de sangue para a mensuração das concentrações plasmáticas de progesterona. Os fragmentos de tecido endometrial obtidos pela biópsia foram fixados no Fixador de Bouin. Posteriormente os fragmentos foram processados e incluídos em parafina. Os cortes foram corados por Hematoxilina-Eosina (HE) para exame histopatológico. As concentrações plasmáticas de P4 foram mensuradas pelo método de enzima-imunoensaio (ELISA). Não foi observada correlação entre as concentrações de P4 e a subfertilidade, sendo estas variáveis tratadas como independentes. Houve uma correlação positiva entre a idade e a subfertilidade (p<0.05), assim, quanto mais velha a égua, maior a subfertilidade. Foi observada uma correlação entre a categoria da biópsia e a subfertilidade (p<0.05), ou seja, quanto mais alterações histológicas, maiores as chances da égua ser subfértil. Contudo, nem todas as éguas classificadas na Categoria I e II levaram a gestação a termo e nem todas da Categoria III tiveram falhas na reprodução, pois, deve-se considerar que outros fatores podem influenciar na manutenção da gestação. A biópsia endometrial demonstrou ser uma técnica fácil, segura, barata e com um desconforto...

The study aimed to compare endometrial histology and plasmatic progesterone (P4) concentration of repeat breeds and healthy mares. The hypothesis was that there is a correlation between infertility and endometrial histology and P4 concentration in both groups. A total of 36 Campolina and Mangalarga Marchador mares in reproductive age (3-23 years) were used, 11 of them were healthy mares (Control group, 7 embryo recipient and 4 embryo donors), and 25 repeat breeders (10 embryo recipient and 15 embryo donors), classified as based on their reproductive history. Endometrial and blood samples were collected for respectively histological and plasma progesterone concentration evaluation. The endometrial samples obtained after biopsy were fixed in Bouin's fluid, processed, included in paraffin, and stained with Hematoxylin-Eosin (HE) for histopathological examination. Plasmatic progesterone concentrations were evaluated by enzyme immunoessay (ELISA). There was no correlation between progesterone concentration and fertility. But there was a positive correlation between age and fertility, as older mares had major tendency of subfertility than younger ones. There was also a correlation between biopsy categories and fertility, as more histological alterations were found, higher were the chances for the mares to be subfertile. However not all mares classified as Category I and II maintained pregnancy until parturition. Other factors could influence pregnancy maintenance. In the same way, not all mares in Category III were infertile. The endometrial biopsy was shown to be an easy and cheap diagnostic technique with minimal discomfort to the animals and, together with other data, to be a very important component in the investigation of mare fertility.

Efeitos da isoflavona de soja sobre os sintomas climatéricos e espessura endometrial: ensaio clínico, randomizado duplo-cego e controlado / Effects of soy-derived isoflavone on hot flushes and endometrial thickness: a randomized, double-blind controlled trial

OBJETIVO: avaliar o efeito da isoflavona de soja sobre os sintomas climatéricos e espessura endometrial em mulheres na pós-menopausa. MÉTODOS: ensaio clínico randomizado, duplo-cego e controlado envolvendo 90 mulheres pós-menopausadas, entre 45 e 60 anos, com queixas de fogachos, acompanhados ou não de outros sintomas climatéricos. Foram randomizadas para receber 50 mg de isoflavona a cada 12 horas, diariamente, por 12 semanas (n=42), ou placebo (n=48), e avaliadas antes e ao final do tratamento, pelo índice menopausal de Kupperman (IK), no qual se registrava a intensidade dos sintomas climatéricos, utilizando uma escala visual analógica de 100 mm. Os fogachos foram avaliados separadamente também. Foram submetidas a uma ultra-sonografia transvaginal para a avaliação da espessura do eco endometrial. Para a análise estatística, empregaram-se o teste do chi2, ANOVA ou t de Student e Mann-Whitney, ao nível de significância de 5 por cento. RESULTADOS: não foram observadas diferenças significantes no IK (64 versus 82, p>0,05) nem nos fogachos (20 versus 20, p>0,05), entre os grupos tratados com isoflavona ou placebo, respectivamente. Também não foram observadas diferenças significantes no IK e nos fogachos, antes e após o tratamento, quando os grupos tratados com isoflavona ou placebo foram analisados separadamente. Nenhuma diferença foi observada na espessura do endométrio após o tratamento entre os grupos tratados com isoflavona ou placebo (0,28 versus 0,26 mm, respectivamente, p>0,05). CONCLUSÕES: a isoflavona de soja, na dose de 100 mg/dia, não é mais efetiva que o placebo para a redução das ondas de calor e sintomas do hipoestrogenismo em mulheres na pós-menopausa e não apresenta efeitos sobre a espessura endometrial.

PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.

Avaliação histológica de pólipos endometriais em mulheres após a menopausa e correlação com o risco de malignização / Histopathologic features of endometrial polyps during menopause and correlation with the risk for concomitant pathology

OBJETIVOS: caracterizar histologicamente pólipos endometriais em mulheres após a menopausa e avaliar o risco de lesões hiperplásicas e neoplásicas neles contidos. MÉTODOS: análise retrospectiva de 82 casos de mulheres portadoras de histopatologia confirmatória de pólipo endometrial, submetidas à polipectomia histeroscópica devido ao diagnóstico de espessamento endometrial à ultra-sonografia transvaginal. Todos os prontuários pertinentes foram revisados para obtenção da história clínica, antecedentes, dados referentes ao exame histeroscópico e resultado final da histopatologia. RESULTADOS: das 82 mulheres avaliadas, 10,9 por cento faziam uso de algum tipo de terapia hormonal e 28 (34,1 por cento) queixavam-se de sangramento por via vaginal. Pólipo solitário foi encontrado em 56 mulheres (68,3 por cento), em 19 casos (23,2 por cento) foram encontrados dois pólipos e em 7 casos (3,6 por cento), três ou mais pólipos. A avaliação histológica definitiva evidenciou pólipo benigno em 63 mulheres (76,8 por cento), pólipos com hiperplasia em 17 casos (20,8 por cento), sendo dez com hiperplasia simples sem atipias (12,2 por cento) e sete com hiperplasia complexa sem atipias (8,6 por cento). Em dois pólipos foi encontrada neoplasia associada (2,4 por cento). Para a análise estatística foi empregado o teste do chi2, corrigido por Yates. Correlacionou-se a histologia dos pólipos com a presença ou não de sangramento genital (p=0,0056), o número de pólipos encontrados por mulher (p=0,921), e o tempo decorrido após a menopausa (p=0,720). CONCLUSÕES: pólipos endometriais são entidades freqüentemente encontradas após a menopausa, associando-se com baixa freqüência a hiperplasias e carcinomas endometriais e apenas o estudo histológico de todo espécime nos permite afastar malignidade.

Padrão endometrial em mulheres submetidas à laqueadura tubária / Endometrial status in women submitted to tubal ligation

OBJETIVO: estudar as modificações histológicas que ocorrem no endométrio de mulheres antes e seis meses após serem submetidas à laqueadura tubária (LT) e correlacionar esses achados com os níveis de progesterona (P4) sérica. MÉTODO: foram incluídas 16 mulheres com ciclos menstruais normais, antes e no sexto ciclo após a LT. Os níveis de P4 foram determinados a partir do 8º dia, de 2 em 2 dias até a ovulação e no 8º, 10º e 12º dia pós-ovulatório ou no 24º dia do ciclo. Realizou-se biópsia endometrial entre o 10º e 12º dia pós-ovulatório ou no 24º dia do ciclo, correlacionando com a P4. A análise estatística foi realizada com uso do teste não paramétrico de McNemar para avaliação da dosagem hormonal e o teste exato de Fisher para a avaliação histológica do endométrio, sendo considerado estatisticamente significativo p<0,05. RESULTADOS: a média de idade foi 34,1±1,3 anos. O intervalo intermenstrual foi 27,1±2,6 dias e a duração do sangramento de 3 a 5 dias, não havendo diferença entre os períodos estudados. Antes da LT, 8/16 (50,0 por cento) dos casos tinham endométrio secretor compatível com o dia do ciclo, 3/16 (18,8 por cento) secretor incompatível e 3/16 (18,8 por cento) disfuncional, sugerindo defeito da fase lútea 6/16 (37,5 por cento). Na fase pós-LT, 7/16 (43,8 por cento) tinham endométrio secretor compatível, 3/16 (18,8 por cento) secretor incompatível e 4/16 (25,0 por cento) disfuncional, sugerindo defeito da fase lútea em 7/16 (43,8 por cento). Em 2/16 (12,5 por cento) dos casos antes da LT e outros 2/16 (12,5 por cento) pós-LT não foi possível fazer a avaliação histológica, devido a material insuficiente ou endometrite inespecífica. Na fase lútea pós-LT, os níveis médios da P4 foram significativamente mais baixos nos dias +8, +10 e +12 do que na pré-LT, sendo na pré-LT, respectivamente, 15,1; 18,0 e 20,7 ng/ml e na pós-LT, 10,6; 8,0 e 5,4 ng/ml (p<0,05). Na pré-LT, 5/8 (62,5 por cento) dos casos com endométrio compatível tinham P4 >10 ng/ml e 3/8 (37,5 por cento) tinha P4 <10 ng/ml. Na pós-LT, quando o endométrio foi secretor compatível, a P4 foi >10 ng/ml em 4/7 (57,1 por cento) e P4 <10 ng/ml em 3/7 (42,9 por cento). Essas diferenças não foram significantes (p>0,05). CONCLUSAO: seis meses pós-LT, não se modificaram o intervalo intermenstrual e a duração do sangramento. A P4 diminuiu durante a fase lútea, embora não tenha interferido na resposta endometrial

randomized trial of metformin-letrozole versus metformin-clomiphene citrate in patients with polycysytic ovary syndrome resistant to clomiphene

To compare the effects of the combination of aromatase inhibitor Letrozole [2.5 mg] and metformin vs. clomiphene citrate [CC: 100 mg] and metformin in clomiphene resistant PCO women. In a prospective randomized trial, a total of 120 cycles in 60 women with clomiphene resistant polycystic ovary syndrome were studied. Patients were randomized into treatment with 2.5 mg of Letrozole daily [29 patients, 53 cycles] or 100 mg of CC daily [30 patients, 67 cycles]. Number of mature follicles, endometrial thickness, estradiol level, pregnancy rate, and miscarriage rate were measured. The mean age, BMI, infertility duration, ovulation rate and the number of mature follicles [>18 mm] in both groups of patients were similar. Total and per follicle estradiol concentrations were significantly lower in the Letrozole group than in the CC group on the day of HCG administration [1664.63 +/- 1350 vs. 981.35 +/- 648 and 783.38 +/- 251 vs. 447.60 +/- 133.36 picomol/L], and the endometrial thickness was significantly higher [0.82 +/- 0.1 vs. 0.55 +/- 0.28 cm]. No difference was found in metformin side effects between both groups. There was no significant difference in pregnancy rate between Letrozole and CC groups [10 cases or 34.5% vs. 5 pregnancies or 16.67% respectively]. Two miscarriages of the 5 pregnancies [40.0%] occurred in the CC group with no abortion in Letrozole group. In comparison to the CC group term pregnancies were also significantly higher in the Letrozole group [10 cases or 34.5% vs. 3 pregnancies or 10.00% respectively]. In women with clomiphene resistant polycysytic ovary syndrome, the combination of Letrozole and metformin is associated with higher pregnancy, and lower miscarriage rates in comparison to CC and metformin

Morphologic aspects of the endometrium, in the estrus phase, of pinealectomized rats

In this paper, it was analyzed morphologically the endometrium of pinealectomized rats, treated or not with melatonin, besides luteinizing hormones levels (LH), stimulating follicle (FSH) and prolactin (PRL). The experimental groups were: I ¡ normal rats, during three months; II ¡ normal rats, during six months; III ¡ pinelalectomized rats evaluated after three months; IV ¡ pinealectomized rats treated with melatonin for three months; V ¡ pinealectomized rats evaluated after six months; VI ¡ pinealectomized rats for three months, and after treated with melatonin for more three months. In the animals from groups III and V, the estrous ciclicity was modified, because beyond the increase in the incidence of the estrus phase, some animals developed a persistent estrus condition. In the other groups the estrous cycle was normal. The hormonal dosage showed that there was an increase in the LH levels in groups III and V, and a small reduction in group IV. There weren't changes between groups VI and II. The levels of FSH and PRL showed themselves reduced in all animals from the pinealectomized group. However, these results didn't show statistically meaningful differences. In groups III, V and VI the endometrium presented a normal aspect except by the presence of several endometrial glands, in most cases, dilated. In the animals that developed persistent estrus, it was observed a very fibrous stroma and rare endometrial glands, some of them presenting non-keratinazed pavement stratified epithelium. The animals in group IV showed a similar endometrium to the control groups. It was concluded that the pinealectomy can draw to the condition of persistent estrus, not producing great variation in the serumal levels of the gonadotrophic hormones, and inducing more effective changes in the glandular epithelium.