Study and evaluation of neovagina epithelium.

OBJECTIVE: To evaluate the newly formed epithelium that develops following a neovaginoplasty performed with Amniotic Membrane. METHODS: A retrospective study conducted at the University Hospital of the Federal University, in Curitiba, Paraná, Brazil. A group of 33 patients with Vaginal Agenesis, most of them amenorrhoeic, either incapable of or having difficulty to perform sexual activity, were separated in Subgroup A (27 patients) with Mayer-Rokitansky-Kuster-Hauser Syndrome, and Subgroup B (six patients) with Androgenic Insensitivity Syndrome (Morris Syndrome). Intervention: Banister-McIndoe neovaginoplasty was performed using amniotic membrane graft in 33 patients of Subgroups A and B and evaluated 60-90 days later by vaginal epithelium biopsies. Main Outcome Measure(s): Transmission Electronic Microscopy (TEM) performed Biopsies of neovaginal epithelium in 10 patients. In 20 patients, we analyzed the levels of intensity and presence of Estrogenic Receptors. RESULTS: Vaginal length was measured (vaginometry) before and after surgery. Before surgery, the vagina was absent in 5 patients (15.15%), vaginal length was 1 cm in 19 patients (57.58%) and in 9 patients (27.27%), it was between 2-3 cm. After surgery, all patients had a vaginal length greater or equal to 5 cm and, in 26 patients (78.8%), vaginal length was 7-8 cm. Seven to eight centimeters average neovagina length allowed patients to have a satisfactory sexual activity after all the surgical procedures to dilate, widen and distend the neomucosa lining. The ERs presented different levels of intensity in the three layers of the neovaginal mucosa. TEM analysis of the vaginal neoepithelium obtained from the amniotic membrane graft revealed all the characteristics of a trophic vaginal epithelium. CONCLUSIONS: In a developing country like Brazil, neovaginoplasty with amniotic membrane graft is considered a great option, being an inexpensive, safe, and easy technique, not requiring any special materials. After a few days (60-90 days), or months, a new epithelium and vagina are obtained allowing patients to have proper sexual activity.

Germ Cell Tumors in Dysgenetic Gonads.

This review describes the germ cell neoplasms that are malignant and most commonly associated with several types of gonadal dysgenesis. The most common neoplasm is gonadoblastoma, while others including dysgerminomas, yolk-sac tumors and teratomas are rare but can occur. The purpose of this review is to evaluate the incidences of these abnormalities and the circumstances surrounding these specific tumors.According to well-established methods, a PubMed systematic review was performed, to obtain relevant studies published in English and select those with the highest-quality data.Initially, the first search was performed using gonadal dysgenesis as the search term, resulting in 12,887 PubMed papers, published, from 1945 to 2017. A second search using ovarian germ cell tumors as the search term resulted in 10,473 papers, published from 1960 to 2017. Another search was performed in Medline, using germ cell neoplasia as the search term, and this search resulted in 7,560 papers that were published between 2003 to 2016, with 245 new papers assessing gonadoblastomas.The higher incidence of germ cell tumors in gonadal dysgenesis is associated with a chromosomal anomaly that leads to the absence of germ cells in these gonads and, consequently, a higher incidence of neoplasms when these tumors are located inside the abdomen. Several hypotheses suggest that increased incidence of germ cell tumors involves all or part of the Y chromosome or different genes.

Environmental toxins and the impact of other endocrine disrupting chemicals in women's reproductive health.

This review aimed to look into agents and mechanisms characterized as endocrine disrupting chemicals (EDCs). These agents are known to cause several harmful effects to the reproductive system of women and wildlife. There is a wide range of chemicals, developed for commercial use mainly in agriculture, which may cause endocrine disruption. Numerous studies show evidence of environmental contamination. However, no one is being held liable for the damages. The most important potentially harmful agents are identified and described, along with the different effects they have on the female genital area. Brazil is a large consumer of pesticides and others chemicals that may interfere with a normal women's life. We analyzed and described the mode of action and the impacts of different EDCs (bisphenols, phthalates, atrazine, polychlorinated and polybrominated biphenyls, DDT-dichlorodiphenyltrichloroethane; DDE-dichlorodiphenyldichloroethylene; DDD-dichlorodiphenyldichloroethane; and DES-diethylstilbestrol) on the genital area, ovarian steroidogenesis, polycystic ovary syndrome, endometriosis, the structure of the uterus and the vagina, and on the formation of leiomyomas.

Germ cell tumors in dysgenetic gonads

This review describes the germ cell neoplasms that are malignant and most commonly associated with several types of gonadal dysgenesis. The most common neoplasm is gonadoblastoma, while others including dysgerminomas, yolk-sac tumors and teratomas are rare but can occur. The purpose of this review is to evaluate the incidences of these abnormalities and the circumstances surrounding these specific tumors. According to well-established methods, a PubMed systematic review was performed, to obtain relevant studies published in English and select those with the highest-quality data. Initially, the first search was performed using gonadal dysgenesis as the search term, resulting in 12,887 PubMed papers, published, from 1945 to 2017. A second search using ovarian germ cell tumors as the search term resulted in 10,473 papers, published from 1960 to 2017. Another search was performed in Medline, using germ cell neoplasia as the search term, and this search resulted in 7,560 papers that were published between 2003 to 2016, with 245 new papers assessing gonadoblastomas. The higher incidence of germ cell tumors in gonadal dysgenesis is associated with a chromosomal anomaly that leads to the absence of germ cells in these gonads and, consequently, a higher incidence of neoplasms when these tumors are located inside the abdomen. Several hypotheses suggest that increased incidence of germ cell tumors involves all or part of the Y chromosome or different genes.

Endocrine disruptors and their influence in the origin of breast neoplasm and other breast pathologies / Disruptores endócrinos e o seu papel na gênese das neoplasias e de outras patologias das mamas

A higher occurrence of early breast cancer in women has created the need to identify possible etiologic agents characterized as direct co-responsible. The motivation for this review is the relevance of detecting potential endocrine disruptors responsible for harmful effects on breast tissue and, consequently, its damage

Uma maior ocorrência no surgimento precoce das neoplasias das mamas em mulheres tem gerado a necessidade da descoberta dos possíveis agentes etiológicos caracterizados como corresponsáveis diretos. A relevância da detecção dos possíveis disruptores endócrinos responsáveis por exercer efeitos danosos nos tecidos mamários e, consequentemente, o seu comprometimento é a motivação da presente revisão

Anomalias do desenvolvimento sexual / Abnormalities of sexual development

As anormalidades da diferenciação sexual são infrequentes na prática clínica. A caracterização de uma ampla variedade de síndromes tem sido muitas vezes confusa, necessitando, com relativa frequência, a consulta de múltiplos livros e uso constante de referências para uma correta compreensão. O presente artigo tem a proposta de revisar as entidades mais frequentes, seus métodos diagnósticos e sua conveniente orientação.(AU)

Abnormal sexual differentiation is not frequently seen in an individual clinician's practice. The categories of many syndromes in this area require special and constant references to review many papers and books to understand these abnormalities. In this paper, the most frequent syndromes are described, and their diagnostic methods and proposals for correct orientation are provided.(AU)

Desenvolvimento sexual e maturação puberal / Sexual and puberal development

Os fenômenos do desenvolvimento sexual e puberal são eventos progressivos e coordenados. Dependem de fatores cromossômicos - gênicos, gonadais e hormonais. Tais eventos nos indivíduos do sexo masculino e feminino, sendo sincrônicos, permitirão um conveniente desenvolvimento sexual e puberal. Analisar tais fenômenos é o propósito deste estudo.(AU)

The sexual and puberal modifications are coordinate and progressive during differents life phases. Many factors are involved like genic-chromosomic, gonadal and hormonal. Those events that occurred in males and females are synchronous and to create a perfect development. Our proposal is review those situations.(AU)

Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA Syndrome).

This paper aimed to report a series of 19 cases of uterus didelphys associated with obstructed hemivagina and ipsilateral renal agenesis. This retrospective descriptive observational study included the medical records of 19 patients seen at the Endocrinology Gynecology Sector of the Obstetrics and Gynecology Department of the Federal University of Paraná, and focused on clinical data, complementary exams, patient management, and follow-up. From the 229 patients with genital anomalies seen between 1984 and 2009, 19 (8.3%) were diagnosed with uterus didelphys with vaginal septum and renal agenesis. The patients had a median age of ±16.3 years. Eight subjects (42.6 %) reported abdominal pain; two of them (0.1%) had pelvic masses and seven (36.8%) had dysmenorrhea. Blood retention was confirmed by ultrasound and/ or magnetic resonance imaging of the pelvis, which revealed the existence of a duplicated uterus of the didelphys type with a cystic mass containing old blood obliterating the hemivagina. Urinary tract examination revealed the existence of ipsilateral renal agenesis. Unusual manifestations such as associated infection and rupture of the vaginal septum during sexual intercourse were also reported. The prevalence of uterus didelphys associated with obstructed hemivagina and ipsilateral renal agenesis was 8.3% in a series of 229 genital anomalies. The observance of clinical features is essential for the early identification of the syndrome and the adequate management of the patients.

Neovaginoplastias: uma revisão dos diversos métodos de tratamento / Neovaginoplasty: a review of different treatment methods

O propósito desta revisão foi analisar os diferentes métodos de neovaginoplastias que vêm sendo executados com o intuito de criar ou ampliar uma neovagina sem excessiva morbidade, a qual seja funcionalmente ativa e traga satisfação com relação a seu aspecto e sua função, promovendo o bem-estar. São descritas todas as possíveis causas de ausência da vagina, sejam elas anomalias congênitas ou mesmo adquiridas. Em vista disso, há uma grande diversidade de métodos terapêuticos propostos, o que indica que o resultado ideal ainda está para ser obtido.(AU)

The purpose of this review was to analyze different neovaginoplasty procedures that have been performed to create or enlarge a new vagina without excessive morbility, which is functionally and aesthetically pleasing, leading to wellbeing. In this issue are described different possible etiologies of vaginal absence, like congenital abnormalities or acquired ones. In this regard, therapeutic methods vary widely, which indicates that ideal results have yet to be obtained.(AU)

Doença celíaca e infertilidade / Celiac disease and infertility

Doença celíaca ou enteropatia por sensibilidade ao glúten é uma doença crônica condicionada pelo desenvolvimento de uma hipersensibilidade ao glúten. É associada a uma ampla gama de manifestações clínicas existindo, simultaneamente, má digestão e um déficit na absorção de muitos nutrientes e vitaminas. Diversos estudos têm mostrado, também, uma maior prevalência desta com quadros de infertilidade, aparentemente sem uma causa definida. Este é o motivo da presente revisão.

Celiac disease or gluten-sensitive enteropathy is a chronic illness characterized by the development of hypersensitivity to gluten. It is associated with a vast array of clinical manifestations, such as the occurrence of digestive problems and poor absorption of nutrients and vitamins. Several studies have also linked it to cases of infertility, apparently, without a known cause. This link is the motivation of the following review.

Histerectomia total versushisterectomia supracervical / Total hysterectomy versus supracervical hysterectomy

A histerectomia é um dos procedimentos cirúrgicos mais frequentemente executados na atualidade. Ela é direcionada ao tratamento de diversas doenças. Além disso, é procedimento de baixa morbidade, com resultados confiáveis, sendo considerada segura. O diagnóstico responsável pela maioria das histerectomias, tanto no Brasil, quanto no resto do mundo, é o sangramento uterino secundário à leiomiomatose uterina. Todavia, mais de 95% das doenças que requerem histerectomia não necessitam, a priori, da remoção da cérvice, por serem condições benignas. Por outro lado, outras morbidades exigem sua remoção; todavia, essas condições respondem por menos de 2% das indicações de histerectomia. A presente revisão direciona-se a abordar os aspectos atinentes à manutenção ou remoção da cérvice uterina em uma histerectomia, reconhecendo as indicações absolutas e relativas que exigem a remoção da cérvice uterina, bem como discutir de forma clara e prática suas controvérsias. Desse modo, o médico assistente poderá orientar suas pacientes quanto à escolha do melhor procedimento cirúrgico, seja a histerectomia total ou a subtotal

Hysterectomy is one of the most frequent surgical procedures. It is employed in the treatment of several disorders. Furthermore, it is considered safe, having a low mortality rate, and reliable results. The main diagnosis for this procedure is secondary uterine bleeding by uterine leiomyomas. Over 95% of the diseases treatable by hysterectomy do not require cervix removal, as they are benign conditions. On the other hand, some diseases do need cervix removal, but these add up to only 2% or less of all clinical indications for hysterectomy. The aim of this review is to address important aspects of both maintenance and removal of the uterine cervix by hysterectomy, to acknowledge its relative and absolute indications and to discuss its controversies clearly and practically. Thus, the assistant physician will be able to counsel their patients on their choices of surgical procedure: either total or supracervical hysterectomy

Neoplasias em gônadas disgenéticas / Neoplasms in dysgenetic gonadal

Conceitualmente, as gônadas disgenéticas são gônadas que não sofreram uma completa diferenciação. Em vista disso, constituem parte de uma ampla gama de entidades clínicas possuidoras de fenótipos e de genótipos diversos. Seus cariótipos contêm o cromossomo Y ou seus fragmentos, ou raramente não os contêm. Essas alterações geram maior risco para a ocorrência de neoplasias nessas gônadas. Na sequência deste estudo apresentamos as neoplasias mais comumente associadas aos diversos tipos de disgenesias gonadais. A neoplasia mais comum é o gonadoblastoma e outros como os disgerminomas e os tumores do seio endodérmico também podem estar associados. A detecção dessas anormalidades de modo precoce é o que nos motivou para a presente revisão

By definition, dysgenetic gonads are those that did not undergo a complete differentiation. They make up a vast array of clinical entities, having different phenotypes and genotypes. Their kariotypes contain the Y chromosome or fragments of it, and, in rare cases, do not contain it. Such alterations generate greater potential for the occurrence of neoplasms in such gonads. This study presents neoplasms which are most commonly associated with several types of gonadal dysgenesis. The most common neoplasia is gonadoblastoma and others like disgerminoma or yolk sac tumors may be associated. The early detection of such potential is the reason for this review

Impacto da radioterapia e da quimioterapia sobre o aparelho genital feminino: procedimentos terapêuticos / Radiotherapy and chemotherapy impact on female genital apparatus: therapeutic procedures

No presente estudo apresentamos os diversos procedimentos terapêuticos existentes com o intuito de obter-se proteção e melhoria dos danos induzidos por radioterapia e quimioterapia no aparelho genital feminino.

The aim of this study is obtain a convenient analysis of different therapeutic methods to improve better conditions before and after radiotherapy and chemotherapy in the female genital apparatus.

O impacto da radioterapia e da quimioterapia no aparelho genital feminino / Radiotherapy and chemotherapy impact on female genital apparatus

O tratamento de diversos tipos de câncer poderá muitas vezes condicionar as pacientes a redução no seu potencial reprodutivo. As pacientes com diferentes neoplasias deverão ser informadas das opções terapêuticas e também das medidas necessárias para preservar sua fertilidade, dos possíveis danos no aparelho reprodutor feminino e das possibilidades futuras quanto à reprodução, antes de receberem qualquer orientação terapêutica. Esse foi o propósito deste estudo.

Treatment of several types of cancer, in many cases, lead to a reduction of the patients' reproductive potential. Such patients must be informed of different therapeutic options and possible resulting damage to the female reproductive tract, as well as all measures necessary for preserving their fertility and future possibilities to reproduce, prior to receiving any therapeutic orientation geared toward this goal. This was the basic purpose of this study.

Malformações genitais e erros genéticos / Genital malformations and genetical errors

A proposta deste estudo foi revisar os fatores genéticos e as anomalias cromossômicas passíveis de condicionarem anormalidades no aparelho genital feminino.

The aim of this study was to review the genetic factors and chromosomal abnormalities that can create Mullerian malformations in females' genital tract.

Biologia molecular das neoplasias ginecológicas: aspectos genéticos: parte II / Molecular biology in gynecological neoplasms: genetic aspects: part II

No presente estudo, são analisadas as possíveis características genéticas que influenciam para o surgimento e o desenvolvimento de diversas neoplasias ginecológicas nos diversos sítios do aparelho genital feminino.

The present study analyses the possible genetic characteristics which influence the onset and development of gynecological neoplasias in diferent parts of the female genital system.