Estrogen regulates the expression of retinoic acid synthesis enzymes and binding proteins in mouse skin.

Topical 17-beta-estradiol (E2) regulates the hair cycle, hair shaft differentiation, and sebum production. Vitamin A also regulates sebum production. Vitamin A metabolism proteins localized to the pilosebaceous unit (PSU; hair follicle and sebaceous gland); and were regulated by E2 in other tissues. This study tests the hypothesis that E2 also regulates vitamin A metabolism in the PSU. First, aromatase and estrogen receptors localized to similar sites as retinoid metabolism proteins during mid-anagen. Next, female and male wax stripped C57BL/6J mice were topically treated with E2, the estrogen receptor antagonist ICI 182,780 (ICI), letrozole, E2 plus letrozole, or vehicle control (acetone) during mid-anagen. E2 or one of its inhibitors regulated most of the vitamin A metabolism genes and proteins examined in a sex-dependent manner. Most components were higher in females and reduced with ICI in females. ICI reductions occurred in the premedulla, sebaceous gland, and epidermis. Reduced E2 also reduced RA receptors in the sebaceous gland and bulge in females. However, reduced E2 increased the number of retinal dehydrogenase 2 positive hair follicle associated dermal dendritic cells in males. These results suggest that estrogen regulates vitamin A metabolism in the skin. Interactions between E2 and vitamin A have implications in acne treatment, hair loss, and skin immunity.

Transcutaneous tibial nerve home stimulation for overactive bladder in women with Parkinson's disease: A randomized clinical trial.

AIMS: This study aims to investigate the efficacy of transcutaneous tibial nerve home stimulation for overactive bladder (OAB) in women with Parkinson's disease (PD). METHODS: The current study is a prospective, randomized, double-blind, sham-controlled trial. Home intervention was carried out and assessments were conducted at a tertiary hospital in South Brazil. Women with PD and OAB symptoms were included in the study. Patients were randomly divided into two groups: (1) stimulation and (2) sham. Both groups underwent intervention at home for 12 weeks. Patients were evaluated at baseline and at 12 weeks (end of intervention), 30- and 90-day follow-up. The primary outcome was the mean reduction in the number of urgency incontinence episodes, and secondary outcomes included daytime and nighttime urinary frequency, urinary urgency episodes, use of pad (reported in a 24-h bladder diary), OAB-V8 and King's Health Questionnaire scores, and maintenance of symptom relief after discontinuation of the intervention. RESULTS: In total, 30 consecutive patients completed the study (15/group). The stimulation group showed a reduction in nighttime urinary frequency (0.9 ± 0.6), urinary urgency (1.0 ± 1.2), urgency incontinence episodes (0.5 ± 0.6), use of pads (1.3 ± 1.2), and OAB-V8 (1.3 ± 1.2) and King's Health Questionnaire scores. In a 30-day and 90-day follow-up, 8 (53.3%) and 5 (33.3%) stimulation patients, respectively, reported full maintenance of symptom relief after discontinuation of the intervention. Stimulation patients presented a statistically significant improvement of symptoms as compared with sham patients (p = .001). CONCLUSIONS: Transcutaneous tibial nerve home stimulation can be used in clinical practice as an effective nonpharmacological resource for the reduction of OAB symptoms in women with PD, and the resulting relief seems to persist in the follow-up (30 and 90 days).

Simplificando a neovaginoplastia na síndrome de Mayer-Rokitansky-Küster-Hauser / Simplifying vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome

Embora sua descrição diste da primeira metade do século XIX, talvez pela sua raridade, o tratamento da Síndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) ainda hoje constitui um desafio. Neste artigo, após breve revisão teórica das características da síndrome, discutimos as técnicas propostas para criação de uma neovagina. Apresentamos a seguir um relato de caso de paciente de 39 anos submetida à Neovaginoplastia de Creatsas, que, pela sua simplicidade, rapidez de recuperação, baixa morbidade e excelentes resultados iniciais, parece ser a opção ideal para as pacientes brasileiras.

Although its description dates from the first half of the 19th century, the treatment of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome remains a challenge, perhaps because of its rarity. In this paper, after a brief theoretical review of the characteristics of the syndrome, the proposed techniques for creating a neovagina are discussed. Then we report the case of a 39-year-old patient submitted to Creatsas neovaginoplasty, which owing to its simplicity, fast recovery, low morbidity and excellent early results, seems to be the ideal choice for Brazilian patients.

Correlação do escore de Oxford modificado com as medidas perineométricas em pacientes incontinentes / Correlation between the modified Oxford scale and perineometry measurements in incontinent patients

Introdução: Diversas técnicas foram propostas para avaliação da musculatura do assoalho pélvico, porém, nenhum método mostrou-se capaz de medir as duas funções desses músculos: elevação e força de compressão. Na rotina de avaliação clínica é comumente empregada a palpação vaginal e, especialmente, o escore de Oxford modificado; entretanto, alguns trabalhos questionam a sensibilidade da escala de Oxford e sua correlação com medidas objetivas de força de contração muscular. Objetivo: neste estudo, propõe-se correlacionar as variáveis medidas na perineometria com o escore de Oxford modificado. Métodos: foram incluídas no estudo 45 pacientes com incontinência urinária que procuraram o ambulatório de Uroginecologia do Hospital de Clínicas de Porto Alegre. As pacientes foram submetidas à palpação vaginal, realizada por uma fisioterapeuta treinada na escala de Oxford, e a medição da força de compressão da musculatura pélvica por meio de balonete conectado a transdutor de pressão. As duas avaliações foram realizadas no mesmo dia. Resultados: encontrou-se correlação significativa (P <0,001) entre o escore de Oxford e as variáveis pressão máxima de contração e tempo de ativação muscular com coeficientes de Pearson de 0,69 e -0,532, respectivamente. Contudo, observa-se uma superposição entre as medidas perineométricas e do escore de Oxford entre categorias adjacentes. Conclusões: Os resultados mostram que apesar de estar incorporada a rotina clínica de avaliação, deve haver restrições quanto ao uso do escala de Oxford com propósitos científicos.

Background: Several techniques have been proposed for the assessment of pelvic floor muscles; however, none of them were able to measure the two main functions of these muscles: lifting and compressive force. Vaginal palpation and especially the Modified Oxford Scale (MOS) are frequently used during routine clinical evaluation, but some studies have questioned the sensitivity of the MOS and its correlation with objective measurements of muscle contraction force. Aim: the objective of this study is to correlate perineometry measurements with the MOS.Methods: Forty-five patients with urinary incontinence treated at the Urogynecology Outpatient Clinic of Hospital de Clínicas de Porto Alegre were included. The patients were submitted to vaginal palpation performed by a physical therapist trained in the MOS. The compression force of their pelvic muscles was measured by means of an air-filled ballonet connected to a pressure transducer. Both tests were carried out on the same day. Results: we found significant correlation (P < 0.001) between the MOS and the variables maximum contraction pressure andmuscular activation time with Pearson's coefficients of 0.69 and -0.532, respectively. However, we found overlapping results between the perineomtry measurements and the MOS scores in neighboring categories. Conclusions: these findings show that, although incorporated into routine clinical evaluation, there should be restrictions to the use of the MOS for scientific purposes.

Vaginal probe transducer: characterization and measurement of pelvic-floor strength.

The pelvic-floor muscles (PFM) play an important role in urinary and fecal continence. Several investigators have studied the PFM using intra-vaginal pressure measurements, but their methods have not been validated. We describe the characteristics of a probe transducer developed to measure PFM strength according to its dynamic response and the effects of temperature variation. This probe transducer was used to evaluate changes in the contraction strength of pelvic muscles in a group of patients who participated in a PFM training program. Experiments allowed the identification of the probe's characteristics at different temperatures, definition of a calibration equation, and measurements of the dynamic response to pressure pulse. Evaluation of patients before and after the PFM training program showed significant differences in the peak pressure achieved during the contraction (p<0.001) and in pressure-rise time (p<0.01). The tests performed with the probe allowed the characterization of the proposed transducer, and the intra-vaginal pressure measurements in volunteers undergoing a PFM training program allowed a quantitative evaluation of the PFM strength.

A new pelvic muscle trainer for the treatment of urinary incontinence.

OBJECTIVE: To describe a new device for home treatment of urinary incontinence (UI) by comparing 3 conservative techniques and monitoring compliance and performance. METHODS: Thirty-two patients with UI were allocated to 1 of 3 intervention groups: pelvic floor muscle exercises (PFME; n=11) alone; PFME combined with biofeedback (n=10); or PFME combined with electrical stimulation (n=11). The outcomes assessed were: changes in quality of life score (QLS), urodynamic and perineometric parameters, episodes of urine loss, subjective assessment of improvement, and actual compliance and performance with treatment. RESULTS: Increased pelvic muscle contraction strength (P<0.05), improvement in QLS (P<0.02), and fewer episodes of urine leakage were observed in all 3 groups (P<0.05). Compliance was similar among the groups (P=0.201). CONCLUSION: All 3 techniques were effective for home treatment of UI, with significant control of symptoms and improved quality of life. The device effectively monitored compliance and performance of exercises.

Oestrogen receptor-beta expression in melanocytic lesions.

Melanomas rarely occur before puberty, have a higher death rate for males, and tend to be more invasive during pregnancy. Prior to the discovery of a second oestrogen receptor (ERbeta), studies with the initial oestrogen receptor, ERalpha, showed no obvious role for oestrogen in the pathophysiology of benign or malignant melanocytic lesions. To investigate the specific immunostaining patterns of ERalpha and ERbeta, benign nevocytic nevi, dysplastic nevi with mild, moderate and severe cytological atypia, lentigo malignas and melanomas of varying depth (Clark) and thickness (Breslow) were studied. ERbeta but not ERalpha was the predominant oestrogen receptor we found in all types of benign and malignant melanocytic lesions. The most intense ERbeta immunostaining was seen in melanocytes in dysplastic nevi with severe cytological atypia and in lentigo malignas. ERbeta expression levels also correlated with the malignant tumor microenvironment; i.e., melanocytes in proximity with keratinocytes>deeper dermal melanocytes in contact with stroma>minimally invasive melanomas>Clark Level III/IV or thick melanomas (Breslow). Discovery that ERbeta expression varies in relation to the tumor microenvironment and increasing depth of invasion suggests its possible usefulness as a surrogate marker for neoplasia and prognosis in malignant melanoma.

Conjugal transformed mycosis fungoides: the unknown role of viral infection and environmental exposures in the development of cutaneous T-cell lymphoma.

The etiology of mycosis fungoides (MF) is uncertain, although infectious agents and other environmental exposures have been implicated. We describe what appears to be the first case in which both a husband and his wife were diagnosed with large-cell transformation of MF. After 10 years of having stage I MF, the wife developed tumors that showed sheets of large transformed cells with dysplastic nuclei on skin biopsies, leading to a diagnosis of transformed MF. Her husband was diagnosed 14 months later with transformed MF following a biopsy of his right arm and leg after a 15-year history of presumed psoriasis. The fact that this rare occurrence happened in a couple who had been married for more than 25 years points to a common environmental exposure. Future studies should aim to clarify the potential role of infectious agents, such as human T-lymphotropic virus I and II, cytomegalovirus, Epstein-Barr virus, and other environmental exposures, in the development of MF.

Hysteroscopy and three-dimensional ultrasonography in uterine diverticulum diagnosis: a case report.

The authors describe a case report of a uterine diverticulum in a postmenopausal woman with abnormal uterine bleeding, confirmed by 3-dimensional ultrasonography and hysteroscopy. They comment on the clinical significance of this rare lesion.

Lack of difference in the rates of hypopigmentation with 90-microsecond pulsed and longer dwell time carbon-dioxide laser resurfacing.

BACKGROUND: Hypopigmentation is an adverse outcome associated with carbon-dioxide (CO(2)) laser resurfacing. A 90-microsecond pulse produces a more favorable postoperative course of healing, erythema, and pain compared with a 900-microsecond dwell time. The rate of hypopigmentation after 90-microsecond pulsed CO(2) resurfacing may also be reduced. To date, there have been no comprehensive reports on the effect of varying pulse duration on the occurrence of hypopigmentation. OBJECTIVE: We sought to investigate the relationship between pulse duration and the occurrence of hypopigmentation after CO(2) laser resurfacing. METHODS: We conducted a retrospective review of 447 consecutive patients who were treated with a 90-microsecond pulsed CO(2) laser (n = 229) or a continuous wave CO(2) laser with a modifiable dwell time (100-950 microseconds, n = 218). Follow-up ranged from 8 to 61 months (median: 27). RESULTS: A series of 4 threshold dwell times (range: 90-950 microseconds) were used to divide patients into 2 treatment groups (above and below) at each threshold. The rates of hypopigmentation between groups were similar (range: 6.37%-9.09%) and serial chi-square testing revealed no statistical differences between groups for each dwell time tested (P < 1.0). CONCLUSION: No significant relationship between pulse duration and the occurrence of hypopigmentation was observed.

Síndrome hemolítico-urêmica pós-parto: relato de caso / Postpartum hemolytic uremic syndrome: a case report

A síndrome hemolítico-urêmica (SHU) é processo microangiopático associado a insuficiência renal, determinando alta morbidade e mortalidade. A gestação pode ser um fator precipitante, por meio de mecanismos ainda não bem estabelecidos. Entram no diagnóstico diferencial a pré-eclâmpsia, a síndrome HELLP, o fígado gorduroso agudo da gestação e a púrpura trombocitopênica trombótica. Relatamos um caso de SHU ocorrendo no pós-parto imediato em paciente com diagnóstico inicial de pré-eclâmpsia. O diagnóstico diferencial foi fundamentado na perda abrupta da função renal, acompanhada de instabilidade pressórica e sinais clínicos e laboratoriais de hemólise. São destacados os métodos diagnósticos disponíveis, manejo terapêutico e fatores prognósticos baseados em revisão de literatura

Tratamento farmacológico da migrânea: uma revisäo / Pharmacological treatment of migraine: a review

Migrânea é uma desordem caracterizada por cefaléias episódicas associadas a sintomas com náuseas, vômitos, fotofobia, fonofobia e fraqueza. Ë uma das queixas mais comuns encontradas por médicos gerais e neurologistas, com prevalência estimada em 12 por cento da populaçäo e predomínio em mulheres. Ë um distúrbio que pode incapacitar os pacientes de realizar atividades usuais, determinando significante impacto econômico. Há três formas principais de manejo desta doença: evitar os potenciais fatores desencadeantes da cefaléia, tratamento efetivo das crises agudas com medicaçöes adequadas e uso regular das medicaçöes preventivas. Apesar de mudanças no estilo de vida e alternativas näo farmacológicas podem ajudar a impedir algumas crises, o suporte principal é o uso precoce das medicaçöes. Atualmente, há uma grande variedade de drogas disponíveis, abrangendo desde os antiinflamatórios näo esteróides (AINEs) até novas drogas mais efetivas, como os agonistas serotoninérgicos 5HTIB/ID ou triptanos. O objetivo desta revisäo é sumarizar as informaçöes presentes na literatura a respeito dos mais diversos esquemas farmacológicos disponíveis para o tratamento agudo e preventivo migrânea

Cistadenoma mucinoso primário de trompa de Fallopio: apresentaçäo de caso / Mucinous cystadenoma of Fallopian tube: case report

As lesöes mucinosas da trompa de Fallopio compreendem uma grande quantidade de processos que incluem metaplasia mucinosa, cistadenoma mucinoso, tumores mucinosos com bixo potencial de malignidade (tumores mucinosos "boderline") e adenocarcinoma mucinoso. As neoplasias mucinosas benignas primárias da trompa de Fallopio säo estremamente raras. Há poucos casos descritos na literatura mundial, e o grande interesse gira em torno da possível associaçäo destas, com neoplasias múltiplas do trato genital, lesöes mucinosas do apêndice e síndrome de Peutz-Jeghers. O presente relato descreve a ocorrência de um cistadenoma mucinoso primário de trompa de Fallopio em uma paciente de 50 anos, menopausada há dois anos, cujo cisto foi identificado inicialmente como de ovário, por ecografia transvaginal, realizada para investigaçäo de um sangramento vaginal. A paciente foi submetida a laparotomia exploradora e teve o diagnóstico feito por exame transoperatório de congelaçäo, confirmado posteriormente por exame anatomopatológico convencional