Pseudociesis. Reporte de caso / Psedocyesis. Case report

Introducción: Según el DSM-V, la pseudociesis se incluye en la categoría "otros síntomas somáticos específicos y trastornos relacionados" y se define como la falsa creencia de estar embarazada que se asocia con signos objetivos y síntomas de embarazo. La confirmación de la pseudociesis se consigue con un resultado negativo de la gonadotropina coriónica humana beta en la sangre y/o la orina asociado a un hallazgo ecográfico negativo. Materiales y métodos: se presenta el caso de mujer con síntomas y signos de embarazo que corresponden a pseudociesis, la paciente siguió creyendo que estaba embarazada debido a sus síntomas, a pesar de que las pruebas de embarazo dieron negativo. Conclusión: La pseudociesis es una enfermedad poco frecuente que a menudo se asocia a otras comorbilidades psiquiátricas y diagnósticos diferenciales poco claros. Es necesario la realización de más estudios, incluyendo series de casos y revisiones sistemáticas para comprender mejor esta infrecuente condición y sus otras variantes.

Introduction: According to the DSM-V, pseudocyesis is included in the category "other specific somatic symptoms and related disorders" and is defined as a false belief of being pregnant that is associated with objective signs and symptoms of pregnancy. Confirmation of pseudocyesis is achieved with a negative blood and/or urine beta-human chorionic gonadotropin result and a negative ultrasound finding. Materials and methods: We present a case of a woman with symptoms and signs of pregnancy corresponding to pseudocyesis, the patient continued to believe she was pregnant because of her symptoms, despite negative pregnancy tests. Conclusion: Pseudocyesis is a rare condition that is often associated with other psychiatric comorbidities and unclear differential diagnoses. Further studies, including case series and systematic reviews, are needed to better understand this rare condition and its other variants.

Pseudocyesis.

Pseudocyesis - a clinical syndrome seen in non-psychotic woman, known since the time of Hippocrates. Pseudocyesis has a psychological basis in which a woman's wish for pregnancy is essential to their identity and self-esteem. Normally, pseudocyesis is seen in women who desperately want to become pregnant, especially those with longstanding infertility. Basically, the treatment of Pseudocyesis is to help these patients recognize the illness and to educate and counsel them. Here is the case of pseudocyesis in which there is no history of long standing infertility. This case is rare and liable to be missed.

comparitive study of mouse ovarian alkaline phosphatase activity in normal and pseudopregnancies

The purpose of this study was to determine alkaline phosphatase [ALP] activity of ovary after ovarian induction using pregnant mare serum gonadotropin [PMSG] and human chorionic gonadotropin [hCG] during implantation periods. A total of 240 female NMRI mice aged 6-10 weeks were selected and divided into control and hyperstimulated. These mice were rendered normal or pseudopregnant. Five mice per each group were sacrificed by cervical dislocation at the first to sixth day of natural or pseudopregnancy. For biochemical assay the samples were obtained from the ovary, then were hemogenated using Tris HCl buffered salin [pH=8.3] and centrifuged with 14000 g. The activity of enzyme was determined using paranitrophenyle phosphate as substrate. Then specific activity of enzyme was calculated according to the total protein. The data were evaluated with Mann whitney test. For histochemistry the samples were cryosectioned [5mm thickness] and the ALP activity was determined by azo-coupling technique using alphanaphtole phosphate as substrate. The pattern of ALP activity in the biochemical and hisotchemical study was the same in each group. The activity of the ovarian ALP was increased during early pregnancy in the control and hyperstimulated natural pregnant groups. There were significant differences between these groups in every days except on the first and fourth day of pregnancy [p<0.05]. The ovarian enzyme activity was increased in pseudopregnancy control until 4th day and in the pseudopregnant hyperstimulation groups until 2nd day of pseudopregnancy then it was decreased. The daily patterny of these alterations were significantly different [p<0.05] comparing the above-mentioned groups. ALP activity was increased in every day of pregnancy [p<0.05] in normal pregnant hyperstimulated group in comparison with the psuedopregnant hyperstimulated group. Thus ovarion hyprstimulation alters the ovarian ALP activity during early pregnancy. These alteration may be due to esteroidogenesis activity of ovarian cells. However more investigation with complementary technique is needed

[Evaluation of acid phosphatase activity alterations in mouse ovary after ovarian hyperstimulation in early stages of pseudo and normal pregnancies until implantation time]

Acid phosphatase [ACP] is a lysosomal enzyme which contributes in ovarian metabolic functions such as oocyte maturation, resumption of mitotic divisions, germinal vesicle breakdown and ovulation. It digestes the corpus lutetium and helps the atresia of follicles by autophagia and hetrophagia activities. Considering the hormonal control of this enzyme, the present study was designed to deterimine the ovarian ACP activity after ovulation stimulation by the administration fo PMSG and hCG during preimplantation period. For this purpose a number of 6 to 10-week old female NMRI mice were selected and randomly divided into control and hyperstimulated groups after the administeration of PMSG and hCG, and later to pregnant and pseudopregnant groups. The mice were rendered pseudopregnant by mechanical vaginal stimulatin. Five mice in each group were sacrificed by cervical dislocation at the first to the sixth day of pregnancy for biochemical assays. The ovarian samples were obtained and were hemogenated and centrifuged at 14000 g. The activity of the enzyme was determined using paranitrophenyl phosphate as substrate and later the specific activity of the enzyme was calculalated according to the amount of total protein. The data were analysed by Mann Whitheny test. Statistical significance was indicated by a P value less than 0.05. For hisotchemical evaluations, the sampels were obtained from one of the ovaries in each mouse and then 5 micro m thick cryosections were prepared. Cryosections were stained by Goumory method. The ACP activity of ovarian tissues in the first day of pregnancy in the normal pregnant and pseudopregnant control groups, hyperstimulated normal pregnant and pseudopregnant groups were 0.34 +/- 0.04 IU/mg, 0.39 +/- 0.04 IU/mg, 0.4 +/- 0.08 IU/mg, 0.45 +/- 0.01 IU/mg respectively and in the fourth day were 0.69 +/- 0.1 IU/mg, 0.61 +/- 0.06 IU/mg, 1.09 +/- 0.10 IU/mg and 0.79 +/- 0.05 IU/mg. The results showed that biochemical findings correlated with histochemical observations. The ACP reaction changes were seen mainly in granulosa cells with a minimum enzyme activity in the first day [zero activity] and a maximum activity in the fourth day of pregnancy [+3]. The increased ACP activity on the 3[rd] 4th days of pregnancy, may be due to the esteroidogenic activity of granulosa cells. Also, the results showed that ovarian hyperstimulation could not change the pattern of ovarian ACP activity during early stages of pregnancy. More research is required in this area for a better understanding of the processes

The changing trends of expression of VEGF and its relationship with the levels of NO in rat corpus luteum of pseudopregnant / 中国应用生理学杂志

<p><b>AIM</b>The expression of VEGF in rat ovaries corpus luteum and its expression pattern were observed to investigate the effect of VEGF on luteal formation and regression.</p><p><b>METHODS</b>The model of immature rat of pseudopregnant was established using pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG), the expression of VEGF in corpus luteum was detected by immunohistochemistry, the levels of VEGF in corpus luteum was measured by ELISA, and the levels of NO in corpus luteum was measured by chemistry assay.</p><p><b>RESULTS</b>VEGF expressed weakly in rat corpus luteum on the day 1, and enhanced gradually from day 3 to day 5, then went up to the peak on the day 7, and maintained to day 9. On the day 11, the expression of VEGF began to decrease. The levels of VEGF were similar to the expression of VEGF. The levels of NO appeared like double wave. The levels increased gradually from day 1 to day 5, and peaked on the day 7, then decreased on the day 9, while lightly increased on the day 11, and showed significant increase and reached the highest on the day 13, then decreased the lowest on the day 15.</p><p><b>CONCLUSION</b>There is a intimate temporal relationship between the expression of VEGF and angiogenesis in corpus luteum, VEGF may play a role in luteum formation by improving angiogenesis mediated by NO, NO may play a role in luteum regression as a luteolytic during the late luteal phase.</p>

Effect of superovulation on the expression of Tissue Inhibitor of Metalloproteinases-3 and Matrix Metalloproteinases-9 in murine endometrium / 대한산부인과학회잡지

OBJECTIVES: The effects of superovulation on the expression of mRNA and protein of TIMP-3 and MMP-9 in murine endometrium were assessed. METHODS: Using murine pregnant uteri of gestation day (g.d.) 4, 5 and 6 after injection of PMSG 5 and 10 IU, the effects of superovulation were assessed and compared with those of natural pregnancy and pseudopregnancy groups using quantitative competitive RT-PCR and immunohistochemical staining. RESULTS: Expression of TIMP-3 mRNA and protein showed an increase in PMSG groups and pseudopregnancy group, while there was no difference in MMP-9 expression between natural pregnancy and PMSG, pseudopregnancy groups on g.d. 4 through g.d. 6. CONCLUSIONS: This study suggests that ovarian hyperstimulation by gonadotropin, which produces many oocytes and embryos, may have a detrimental effect on embryonic implantation and its relevant endometrial remodeling process by increase in expression of TIMP-3 in murine endometrium.

Thymic proliferative response during different physiological states: a comparative study

Objective - To study the thymic proliferative response during different physiological states to distinguish those changes due to alterations in steroid hormone secretion from those resulting from the presence of spermatozoa and/or early conceptual products in the female reproductive tract. Method - Using mature female rats of an inbred AO [RT1u] strain, observations on the thymus were made at 24 hour intervals during the oestrous cycle, early pseudopregnancy and early syngeneic pregnancy. Each daily group contained a minimum of 6 animals. Results- During the oestrous cycle, a significant mid-cycle increase of thymocyte proliferation occurred during dioestrus which peaked on day 2, and as a repetitive response may be a preparation for a coital challenge. This response may be oestrogen-dependent since oestrogen levels begin to increase during early dioestrus. The induction of pseudopregnancy generates a comparable but delayed increase in thymic proliferative activity. Since thymocyte proliferation and oestrogen secretion both peak on day 3 of pseudopregnancy, such a response may indeed also be oestrogen-dependent. After syngeneic mating, there was a significant depression in thymic proliferative activity on day 3 followed by a significant increase on day 5 compared with the same days of pseudopregnancy. Conclusion - This initial depression of proliferative activity may be induced by the immunosuppressive action of seminal plasma, to safeguard the preimplantation conceptus while the day 5 increase in cellular proliferation suggests a response to implantation

Rol del oxido nítrico en la síntesis de prostaglandina F2alpha y progesterona durante la luteolisis en la rata / Role of nitric oxide in the synthesis of prostaglandin F2alpha and progesterone during luteolysis in the rat

En el cuerpo lúteo (CL), la prostaglandina F2alpha (PGF2alpha) es un agente luteolítico. El óxido (NO) es una molécula mensajera capaz de regular diversos procesos patofisiológicos, algunos de ellos relacionados com el tracto rerpoductivo femenino. El objetivo del presente estudio fue investigar el rol del NO ovárico en la producción de PGF2alpha y progesterona (Pg) durante la regresión del CL en la rata. Se utilizó para ello el modelo de la rata pseudopreñada, obteniéndose un cuerpo lúteo funcional por 9 + 1 días. Fueron inyectados en bursa ovárica dos inhibidores competitivos de la óxido nítrico sintasa (Nos), NG-monometil-L-arginina (L-NMMA), 1 mg/kg); NW-nitro-L-arginina metil éster (L-NAME, 3 mg/kg) así como también un generador de NO como el nitroprusiato sódico (SNP, 0.05 mg/kg). Los resultados obtenidos indican que el NO, producido en el ovario durante la fase final del desarrollo del CL (días 8 y 9), actuaría aimentando la producción de PGF2alpha ovárica y disimuyendo la progesterona sérica desencadenando la regresión luteal. Se há propuesto un mecanismo de feedback positivo entre la PGF2alpha y el NO hacia la fase final del desarrollo del Cl, para asegurar la luteólisis. Esto fue evaluado mediante la medición de la actividad de la Nos, luego de haber inyectado una dosis luteolítica de PGF2alpha (3mug/kg) a ratas en estadio medio (día 5) y tardío (día 9) del desarrollo luteal. Los resultados confirmaron nuestra hipótesis; no se observó un efecto en el estadio medio del desarrollo del Cl, pero en la fase final se encontró un aumento en la actividad de la enzima Nos en aquellos animales que habían recibido la dosis mencionada de PGF2alpha.

Pre-implantation immunosuppression in the pregnant rat: a possible role of seminal fluid

Successful reproduction involves exposure of the female to significant antigenic challenge. These experiments were done to test the possibility/hypothesis that seminal fluid has an immunosuppressive role in the early stages of pregnancy, which could protect the conceptus from immunological attack. A highly inbred strain of rat AO [RT1[u]] was used in this study. Eleven groups of animals were examined, one during the estrous phase of the ovarian cycle to provide base-line data, five during pseudopregnancy, designated as controls, and five groups during syngeneic pregnancy. Each group contained a minimum of six animals. For each animal, body weight and organ/tissue weights of the uterus, thymus, uterine and popliteal lymph nodes, were recorded together with total cell counts of the lymphoid tissues and their proliferating cell counts. The material was collected during each of the first five days of pregnancy and pseudopregnancy. The present study supports an immunological suppression by seminal fluid during early pregnancy as shown by a significant sustained depression of the proliferative lymphocyte response in the uterine regional lymph nodes

A search for immunocontraceptive agent from marine sources--role of antispermatheca globulin of Telescopium telescopium on fertility regulation in male rat.

Polyclonal antisera were developed in rabbits against 'spermatheca', the reproductive gland of T. telescopium, a marine mollusc. The gland contains spermatozoa. Antisera and its IgG fraction (ASTG) indicated common antigenic determinants by immunodiffusion and had titer values 81920 and 1280 against crude antigen extract. Cycling female rats when exposed to passively immunized male rats with different doses of ASTG, had reduction in implantation sites and litter size. Females had pseudopregnancy when exposed to higher doses of immunized males and had normal cycle after 20 days in average. ASTG in male rats caused decrease in weight of the reproductive glands, alteration in sperm concentration, motility and morphology, formation of multinucleated giant cells and vacuoles leading to arrest of spermatogenesis and reduction in seminiferous tubular diameter. The effects were dose dependent with reversible infertility. The results indicate presence of a common antigenic determinants which cross-react with vertebrates and existence of common relation through phylogenetic evolution and their immune responses.

Protective effect of ectopic pituitary graft on nutritional stress-induced implantation failure in mice.

Implantation failure in newly inseminated mice induced by food deprivation was prevented by the presence of an ectopic pituitary graft. Since a pituitary graft in an ectopic site is known to secrete prolactin continuously, it is suggested that suppression of implantation failure in pituitary-grafted females is due to the luteotrophic support provided by the graft. The results provide supportive evidence for the view that depression of hypophysial prolactin is the primary endocrine cause of the nutritional stress-induced implantation failure in mice.

Modelo experimental en la rata, pseudo-preñada diabetica, preimplantación y postinducción decidual (+) / Experimental model in rats with diabetic pseudopregnancy, preimplantation and decidual post induction

El estudio histológico del tejido decidual en la rata pseudopreñada, reveló una onda constante de figuras mitóticas que, partiendo de la decidua antimesometrial, se desplazó hacia la decidua mesometrial y, finalmente, hacia el triángulo mesometrial. Este y otros cambios morfológicos, como el estudio cualitativo de la superficie endometrial con microscopia eletrónica, fueron comparados con aquellos encontrados en la rata pseudopreñada diabética. No se encontraron diferencias estadísticamente significativas en cuanto a peso uterino, distribución de figuras mitóticas, ni distribución de glicógeno en los días 7 y 10 de pseudopreñez. Tampoco se observaron diferencias cualitativas entre la superficie epitelial del grupo control y diabético. El día 13, sin embargo, se encontraron tres diferencias estadísticamente significativas. Se observó en el grupo diabético: 1) caída en el peso uterino; 2) menor incidencia de figuras mitóticas en el triángulo mesometrial, y 3) menor grado de diferenciación de las arterias espirales

Induçäo de pseudogravidez em ratas pela administraçäo intraventricular de 6-hidroxidopamina / Induction of pseudopregnancy in rats by the intraventricular administration of 6-hydroxydopamine

Procurando verificar se a destruiçäo das vias catecolaminérgicas pela 6-hidroxidopamina modificava o ciclo estral de ratas, quando injetada no ventrículo lateral, observou-se o aparecimento de um quadro de pseudogravidez. Os resultados mostraram que esses animais apresentavam uma diminuiçäo da ingestäo de alimentos que se correlacionava com o período de pseudogravidez. Vários autores descrevem este efeito com a administraçäo de drogas antidopaminérgicas e discutem os resultados em termo de interaçäo ao nível de transmissores sinápticos. No presente trabalho, mostra-se que o efeito da 6-hidroxidopamina, que poderia ser discutido como uma inibiçäo do fator inibidor da prolactina, causando pseudogravidez, pode ser originado apenas pelo estresse da privaçäo de alimentos

Tratamiento medico de la endometrosis. Experiencia personal. / Medical treatment of endometriosis. Personal experience

El tratamiento medico lo hemos realizado con: a) Pseudogestacion, b) Danazol. Pseudogestacion (Metrulen) es un metodo utilizado teniendo en cuenta el efecto beneficioso del embarazo sobre la endometrosis.El Danazol es una sustancia de accion androgenica que suprime el pico en el dia 14 de LH y FSH y por lo tanto lleva a una anovulacion y amenorrea que conlleva a una atrofia de los implantes endometrosicos.De las 58 pacientes, 32 fueron tratadas con Metrulen y se embarazaron 8(25%). En las 26 restantes se complemento el tratamiento con cirugia (30,7%). De 24 pacientes 8 fueron medicadas con Danazol y se embarazaron 3(38%). De las 16 restantes se embarazaron 6(38%). O sea que, de los 40 casos de tratamiento medico puro, tuvimos 11 embarazos; en 42 pacientes de tratamiento medico y quirurgico combinados, 14 gestaciones, lo que representa para las 72 pacientes tratadas, 25 exitos (30,48%)

Effects of prostaglandin F2 alpha and its synthesis inhibitor indomethacin on corporaluteal functions in pseudopregnant rats.

The effects of PGF2 alpha and its synthesis inhibitor indomethacin on corporaluteal (CL) functions were studied in adult pseudopregnant rats. The CL functions were assessed by studying the duration of pseudopregnancy and histological changes in the ovary. Administration of PGF2 alpha (4 mg/kg BW) significantly (P less than 0.001) shortened the duration of pseudopregnancy. Histological examination of ovaries revealed regressed CL. Administration of indomethacin, on the other hand, significantly (P less than 0.001) prolonged the duration of pseudopregnancy. Histological examination of ovaries revealed large and well formed CL, the diameters of which were significantly (P less than 0.05) increased. Administration of indomethacin and PGF2 alpha simultaneously, however, keeps the duration of pseudopregnancy within normal limit. Further, the shortening in the duration of pseudopregnancy by PGF2 alpha alone was completely reversed by exogenous administration of progesterone. Since PGF2 alpha shortens and indomethacin (an inhibitor of PGF2 alpha synthesis) prolongs the duration of pseudopregnancy, it is concluded that PGF2 alpha acts as a luteolytic agent in rats. The mechanism of luteolysis is most likely to be due to decrease plasma progesterone level. An estimation of blood progesterone level after administration of PGF2 alpha to pseudopregnant rats is therefore, suggested.