Gonadotropin and Estradiol Levels after Leuprolide Stimulation Tests in Brazilian Girls with Precocious Puberty.

STUDY OBJECTIVE: To determine the best cutoff value on the leuprolide stimulation test for the diagnosis of central precocious puberty (CPP) in a Brazilian population. DESIGN, SETTING, AND PARTICIPANTS: This observational study included 60 girls with CPP, as shown on the basis of serum concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) before and 3 hours after subcutaneous administration of 500 µg leuprolide acetate and by measuring serum estradiol concentrations 24 hours later. Six months later, each subject was clinically evaluated to determine whether she had experienced progressive or nonprogressive puberty. MAIN OUTCOME MEASURES: Analyzing the best cutoff for LH after subcutaneous administration of 500 µg leuprolide acetate. RESULTS: The best cutoff was a 3-hour LH level of greater than 4.0 mIU/mL, providing the highest sensitivity (73%) and specificity (83.1%), whereas a 3-hour LH level greater than 8.4 mIU/mL had a specificity of 100%. A 24-hour E2 concentration greater than 52.9 pg/mL had a sensitivity of 68% and a specificity of 74%. There was no association between pubertal development and disease progression. Signs such as thelarche and pubarche did not determine the evolution of the disease (P = .17). Clinical condition was associated with bone age/chronological age (P = .01), basal LH (P < .01), 3-hour LH (P = .02), baseline LH/FSH indices (P < .01) and after 3 hours (P < .01), and E2 at 24 hours (P = .02). CONCLUSION: The optimal parameter indicating hypothalamic-pituitary-gonadal axis activation in our sample was a 3-hour LH level greater than 4.0 mIU/mL. A diagnosis of CPP, however, should be based on a set of criteria and not on an isolated measurement, because typical laboratory findings associated with CPP may not be present in all patients.

Comparative study of the effects of combined oral contraceptives in hemostatic variables: an observational preliminary study.

Thrombotic risk is associated with the estrogen dose and type of progestin in combined oral contraceptives. Studies published since 1990 showed that third-generation progestins have larger risk to contribute to thrombosis development than the second-generation. However, there are conflicts in the literature regarding the thrombotic risk associated to the drospirenone progestin. So, this study aimed to evaluate the effects of 3 formulations of contraceptives containing ethinylestradiol (EE) (20 and 30 µg) combined with drospirenone versus levonorgestrel combined with EE (30 µg) in hemostatic parameters. This cross-sectional study included 70 healthy women between 18 and 30 years, BMI 19 to 30 kg/m², not pregnant, non-smokers, and users or non-users (control) of contraceptives for a minimum period of 6 months. The following parameters were assessed: prothrombin time (PT), Factor VII, activated partial thromboplastin time (aPTT), Factor XII, fibrinogen, Factor 1 + 2, Protein C, Protein S, antithrombin, D-dimers, and plasminogen activator inhibitor-1. Significant alterations were found in PT, aPTT, fibrinogen, D-dimers, and protein S, all favoring a state of hypercoagulation for contraceptive containing DRSP/20EE. Both contraceptives containing DRSP/30EE and LNG/30EE promoted changes that favor the hypercoagulability in the coagulant variable PT and in the anticoagulant variables Protein S and Protein C, respectively. We suggest that the progestin drospirenone can contribute to an inadequate balance among procoagulant, anticoagulant, and fibrinolytic factors, since that the contraceptive containing the lowest dose of estrogen and drospirenone (DRSP/20EE) caused a higher number of hemostatic changes.

Variations of jitter and shimmer among women in menacme and postmenopausal women.

The objective of the study was to analyze comparatively the jitter and shimmer values of spoken voice among women in menacme and menopausal women using or not hormonal replacement therapy (HRT). Forty-five women were studied, divided into the following groups: Control Group (CG), 15 women aged 20-40 years with regular menstrual cycles who did not take hormonal contraceptives; Treated Group (TG), 15 women aged 45-60 years with at least 2 years of menopause, under continuous HRT with 1 mg estradiol valerate + 90 microg norgestimate per day for at least 6 months; Untreated Group (UG), 15 women aged 45-60 years with at least 2 years of menopause who did not use HRT. Mean age was 30.3, 54.5, and 56.5 years for CG, TG, and UG, respectively. All subjects were submitted to acoustic analysis of jitter and shimmer for the sustained vowels /e/ and /i/. Mean jitter values were 0.56%, 0.64%, and 0.56% for the vowel /e/ and 0.88%, 0.79%, and 0.68% for the vowel /i/ for CG, TG, and UG, respectively. Mean shimmer values were 4.17%, 4.38%, and 4.77% for the vowel /e/ and 5.19%, 4.59%, and 5.37% for the vowel /i/ for CG, TG, and UG, respectively. There were no significant differences between the groups studied. The results obtained here by the methodology used suggest that there were no significant differences in jitter and shimmer when we assessed the sustained vowels /i/ and /e/ between menopausal women using or not HRT or between young and menopausal women treated or not.

Epitelizaçäo vaginal com membrana amniótica em neovaginoplastia / Vaginal epithelialization with amniotic membrana in neovaginoplasty

Entre os vários métodos utilizados na neovaginoplastia, o uso do âmnio como tecido de revestimento tem produzido resultados satisfatórios. Utilizando o âmnio em nossas 15 pacientes, obtivemos epitelizaçao similar àquela observada na mucosa vaginal normal. Estes resultados demonstram que o uso do âmnio é uma das melhores opçoes terapêuticas na neovaginoplastia.

Aboliçao do reflexo de sucçäo mamilar com o uso de anestésicos / Abolition of the mammillary sucking reflex using anesthetics

Neste trabalho, os autores estudaram o efeito de anestésicos (xilocaína e nembutal) sobre o reflexo da sucçao mamilar em ratas. As ratas lactentes foram submetidas a cinco tratamentos diferentes antes de serem colocadas para amamentar os filhotes. a) Injeçao intraperitoneal (IP) de soro fisiológico (grupo-controle). b) Anestesia com nembutal IP (40mg/Kg). c) Injeçao de xilicaína em torno dos mamilos (infiltraçao local de 0,1 ml de xilocaína a 1 por cento em cada mamilo). d) Injeçao IP de ocitocina (100mUI) após prévia anestesia com xilocaína, como descrito em c. e) Injeçao IP de ocitocina (100mUI/ml) após prévia anestesia com nembutal, como descrito em b. As ninhadas foram pesadas antes e trinta minutos após a mamada, e a diferença de peso anotada. Os resultados mostraram que no grupo-controle (A) a ninhada ganhou em média 7g, enquanto que no grupo B (nembutal) o ganho de peso médio foi de 0,9g. No grupo C houve, em média, perda de 2g (p<0,05 em relaçao ao grupo-controle). Nos grupos D e E (que receberam anestésico + ocitocina) houve ganho de 13g e 9,5g, respectivamente. Os resultados demonstram o papel da ocitocina no processo de lactaçao, ao mesmo tempo que evidenciam que os anestésicos interferem no reflexo de sucçao mamilar, abolindo a liberaçao de ocitocina, seja pela interferência a nível central (nembutal) ou localmente (xilocaína).

Puberdade precoce: abordagem diagnóstica / Precocious puberty: diagnostic approach

Foram estudadas 32 crianças com puberdade precoce (PP), sendo 11 delas PP verdadeira idiopática, seis de pseudopuberdade precoce, nove de telarca precoce (uma delas iatrogênica e seis de pubarca precoce. Metade dos 11 casos de puberdade precoce verdadeira mostraram níveis pré-puberais de LH e FSH, e 85 por cento níveis pré-puberais de E2. Nas pacientes com pubarca precoce, 83 por cento tinham níveis elevados de DHEA-S. O teste do LHRH foi realizado em nove casos, e o padrao de resposta tipo adulto foi encontrado em sete. Um caso de gonadoblastoma e um de telarca precoce nao mostraram este padrao. Em 47,4 por cento dos casos, a idade óssea mostrou-se avançada (defasagem maior que um ano e meio) em relaçao à idade cronológica.

Alteraçöes endócrinas da síndrome da sela vazia / Endocrine alterations in empty sella syndrome

In this study we analyzed the clinical signs and symptoms and the major endocrine alterations detected in four patients with the empty sella syndrome, who were followed at the Tocogynecological Endocrinology out patient clinic of the University Hospital, Faculty of Medicine of Ribeirao Preto. As also reported in most studíes available in the litterature, all of our patients were hypertensive, obese and multiparae, and cephalea was their most common clinical complaint. Although hormonal levels were within normal limits, two patients presented marked hirsutism and required the use of specifíc medication.