Terapia fotodinâmica em células de tumores pancreáticos humanos: eficiência e análise das vias mediadoras de citotoxicidade / Photodynamic therapy in human pancreatic tumors: efficiency and analysis of cytotoxicity mediator pathways

O adenocarcinoma de ducto pancreático (PDAC) é a quarta causa de morte em decorrência de neoplasias nos países ocidentais. Atualmente, a cirurgia ressectiva é a única possibilidade de cura para a doença, porém, a recidiva tumoral acontece em menos de um ano após a intervenção cirúrgica, mesmo com a quimioterapia adjuvante. A terapia fotodinâmica (PDT) é uma alternativa promissora no tratamento do câncer. No entanto, pouco se sabe sobre o uso da PDT em tumores pancreáticos. Portanto, o objetivo deste trabalho foi avaliar a eficiência da PDT com o azul de metileno (MB) como fotossensibilizador (MB-PDT) em induzir a morte de linhagens de PDAC humanas (AsPC-1, Panc-1, MIAPaCa-2 e BxPC-3) e estudar a contribuição de vias de necrose regulada nos efeitos citotóxicos da terapia sobre estes modelos. Os resultados obtidos mostraram que a MB-PDT foi capaz de induzir a morte massiva das células de PDAC. Além disso, eles indicaram que há dois perfis de susceptibilidade entre as quatro linhagens estudadas quando submetidas a MBPDT com 4,5 J/cm2 de energia e 6min de irradiação. De acordo com os dados apresentados, a diferença nas sensibilidades das linhagens à terapia não está associada à diferenças na capacidade de incorporação do MB ou na localização sub-celular do fotossensibilizador nas diferentes células, uma vez que a localização é, predominantemente, lisossomal em todas elas. Adicionalmente, mostrou-se que as linhagens menos susceptíveis ao tratamento, MIAPaCa-2 e Panc-1, apresentam níveis significativamente menores de RIPK3 e MLKL, dois dos componentes do necrossomo, essenciais para a execução da necroptose. Além disso, foi visto que a MB-PDT induz um aumento de fosforilação de MLKL em AsPC-1, demonstrando a ativação da necroptose após a terapia nestas células, mas não em MIAPaCa-2 (menos responsiva à terapia com 4,5 J/cm2 deenergia e 6min de tempo de irradiação). Ainda, a inibição da via de sinalização necroptótica diminuiu significativamente as porcentagens de morte das células mais susceptíveis (BxPC-3 e AsPC-1), não alterando a resposta de Panc-1 e MIAPaCa-2, corroborando a ativação e importância da necroptose para a citotoxicidade da MB-PDT. Finalmente, neste trabalho foi mostrado que o aumento do tempo de irradiação, mantendo-se a quantidade total de energia aplicada no tratamento, melhora a eficiência da MB-PDT em induzir a morte das células que apresentam limitações para executar a necroptose, sugerindo que mais de uma via de morte esteja sendo ativada após a terapia e que o tempo de irradiação atuaria modulando esta ativação. Complementarmente, foi mostrado que os tempos maiores de irradiação aumentam o estresse oxidativo intracelular que é acompanhado por uma diminuição significativa do conteúdo intracelular de glutationa reduzida (GSH), indicando, preliminarmente, que a ferroptose pode estar sendo acionada após os protocolos mais longos de irradiação. Coletivamente, os resultados apresentados neste trabalho confirmam a eficiência da MB-PDT no tratamento de diferentes linhagens de PDAC, indicando que a necroptose está sendo ativada e contribuindo para a citotoxicidade da terapia sobre as células que não apresentam resistência à esta via de morte. Ainda, eles demonstram que o aumento do tempo de irradiação pode transpor a barreira de resistência de algumas linhagens à terapia, provavelmente por induzir a ativação de outras vias de necrose regulada, mostrando a importância da otimização do protocolo de tratamento no aumento da eficiência da MB-PDT sobre os tumores de pâncreas. Finalmente, os resultados confirmam a MB-PDT como alternativa eficaz no tratamento do PDAC, apresentando um amplo espectro de atuação sobre subtipos tumorais resistentes à vias clássicas de morte celular, uma característica importante no contexto de uma terapia anti-cancer

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of death due to neoplasms in western countries. Currently, resective surgery is the only therapetical approach to cure this disease, but tumor´s recurrence occurs less than one year after the surgery, even with adjuvant chemotherapy. Photodynamic therapy (PDT) is a promising alternative for the cancer treatment. However, the efficacy of PDT to treat pancreatic tumors as well as the mechanisms involved in the induction of tumorigenic cell death remain unclear. For this purpose, in this study, we set out to evaluate the efficacy of PDT using methylene blue (MB) as a photosensitizer (MB-PDT), in inducing death of human PDAC derived cell lines (AsPC-1, Panc-1, MIAPaCa-2 and BxPC-3) and to deeper investigate the contribution of necroptosis to the cytotoxic effects of the therapy. We observed that MB-PDT was able to induce massive death of PDAC cells. Moreover, our results indicated that upon MB-PDT (4.5 J/cm2 energy and 6min of irradiation time), there were two susceptibility profiles among the four cell lines studied. Data also showed that this differential profile of cell response was neither associated with the differences in the MB incorporation capacity nor with the subcellular location of the photosensitizer, since the localization was predominantly lysosomal in all of tested cell lines. In addition, less susceptible cells, MIAPaCa-2 and Panc-1, showed significantly lower levels of RIPK3 and MLKL, two of the necrosome components, essential for triggering necroptosis. Furthermore, while MB-PDT (4.5 J/cm2 and 6min of irradiation) has been able to increase MLKL´s phosphorylation levels, an essential step in necroptosis induction, in AsPC-1cells, less responsive MIAPaCa-2 cells presented no variations on the phosphorylation state of this pseudokinase. Moreover, pharmacological inhibition of the necroptotic signaling pathway significantly decreased cell death percentages of the most susceptible cells (BxPC-3 andAsPC-1), without altering the response of Panc-1 and MIAPaCa-2, corroborating that activation of necroptosis was strongly involved in the cytotoxicity of MB-PDT. Finally, this work showed that increasing the irradiation time improved the efficacy of MB-PDT in killing cells which display limitations to perform necroptosis, suggesting that the irradiation time would be modulating the degree of oxidative stress generated and this stimuli would in turn, be responsible for triggering other regulated cell death pathways in a RIKP3 and MLKL independent way. Indeed, this increase in oxidative stress was accompanied by a significant decrease in GSH, a global indicatior of less antioxidant cell capacity, preliminarily pointing at the induction of ferroptosis by longer irradiation protocols. In summary, we demonstrated that MB-PDT is able to induce cell death in different PDAC cell lines and that different regulated cell death mechanisms are being activated upon MB-PDT induction. Furthermore, it was demonstrated that increased irradiation time may overcome the resistance barrier of some cell lines, probably inducing the activation of other regulated cell death pathways, showing the importance of optimizing the irradiation protocol in order to maximize the efficacy of the therapy. Finally, our observations point MB-PDT as an alternative and effective therapy for pancreatic cancer treatment, displaying a broad-spectrum action on tumors displaying different resistance mechanisms to classic cell death pathways, a desired property for improving an anticancer therapy

A flexible ontology for inference of emergent whole cell function from relationships between subcellular processes.

Whole cell responses arise from coordinated interactions between diverse human gene products functioning within various pathways underlying sub-cellular processes (SCP). Lower level SCPs interact to form higher level SCPs, often in a context specific manner to give rise to whole cell function. We sought to determine if capturing such relationships enables us to describe the emergence of whole cell functions from interacting SCPs. We developed the Molecular Biology of the Cell Ontology based on standard cell biology and biochemistry textbooks and review articles. Currently, our ontology contains 5,384 genes, 753 SCPs and 19,180 expertly curated gene-SCP associations. Our algorithm to populate the SCPs with genes enables extension of the ontology on demand and the adaption of the ontology to the continuously growing cell biological knowledge. Since whole cell responses most often arise from the coordinated activity of multiple SCPs, we developed a dynamic enrichment algorithm that flexibly predicts SCP-SCP relationships beyond the current taxonomy. This algorithm enables us to identify interactions between SCPs as a basis for higher order function in a context dependent manner, allowing us to provide a detailed description of how SCPs together can give rise to whole cell functions. We conclude that this ontology can, from omics data sets, enable the development of detailed SCP networks for predictive modeling of emergent whole cell functions.

[The Paris system for classification of urinary cytology]. / Das Paris-System zur Klassifikation der Urinzytologie.

A uniform classification system for reporting urinary cytology has not been available until recently, although urinary cytology represents an important volume of specimens in cytopathology laboratories and is well-established in the diagnosis and follow-up of patients with urothelial carcinoma. The Paris system is the first internationally accepted classification system, which allows uniform reporting of urinary cytology based on standardized morphological criteria. It emphasizes the detection of potentially life-threatening high-grade urothelial carcinomas and well-defined diagnostic categories have been developed. Notably, it aims at reducing the diagnosis of equivocal atypia and additionally at confining indications for a rational use of ancillary molecular techniques. The Paris system has already gained broad acceptance both in the cytology and urology communities, and promises to enhance the value of diagnostic urinary cytology.

Neoplasia intraepitelial anal: una revisión de conjunto / Anal intraepitelial neoplasia: a narrative review

La neoplasia intraepitelial anal (AIN) constituye un importante problema de salud en ciertos grupos de riesgo como los pacientes con inmunodepresión de diverso origen, varones que mantienen relaciones sexuales con otros hombres, y mujeres con antecedentes de alteraciones en la citología cervical y/o vaginal. Está bien demostrada su relación con la infección del virus del papiloma humano (HPV), sin embargo se desconocen muchos de los factores implicados en la progresión y regresión de la infección viral a la displasia y al carcinoma anal. La pruebas diagnósticas de elección son la citología del canal anal y la anuscopia de alta resolución con biopsias dirigidas, aunque existe controversia sobre la necesidad de realización de la misma en poblaciones de riesgo. El tratamiento del AIN depende de los factores de riesgo y la necesidad de tratamiento local es controvertida debido a la alta tasa de recurrencia y morbilidad de las técnicas utilizadas. La biopsia quirúrgica está justificada sólo ante lesiones macroscópicas sugestivas de progresión. La vacunación frente al HPV para una prevención primaria en pacientes de alto riesgo ha sido debatida entre diferentes grupos, sin embargo no existe consenso sobre su implantación ni tampoco sobre la realización de un cribado en esta población (AU)

Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population (AU)

Prevalência de alterações citológicas anais em pacientes com citologia cervical anormal / Prevalence of cytological anal abnormalities in patients with abnormal cervical cytology

A incidência do carcinoma escamoso anal vem crescendo expressivamente. Principal fator associado a ele é o Papiloma Vírus Humano (HPV). Estudos epidemiológicos mostram fases pré-clínicas antes do início do câncer anal. Esse trabalho visou a estimar a prevalência de alterações citológicas anais em pacientes com citologia cervical anormal e sem lesão macroscópica HPV induzida na região anal. Foram selecionadas 70 mulheres com citologia cervical alterada, soronegativas para o Vírus da Imunodeficiência Humana (HIV) e sem lesão perianal macroscópica pelo HPV. As pacientes foram submetidas a um questionário e foram realizadas coletas de captura híbrida anal e cervical, bem como de uma amostra de citologia oncológica cervical e duas amostras anais. A prevalência das alterações citológicas anais encontrada foi de 71,4%, sendo que 57,1% apresentaram captura híbrida anal positiva. A prevalência de captura híbrida anal positiva para HPV de alto risco oncogênico em paciente com citologia cervical de atipia escamosa de significado indeterminado, provavelmente não neoplásico (ASC-US) e de lesão intraepitelial escamosa de baixo grau (LSIL) foi de 27,1% e, em pacientes com citologia cervical de atipia escamosa de significado indeterminado, não podendo excluir lesão intraepitelial de alto grau (ASC-H), lesão intraepitelial escamosa de alto grau (HSIL), e carcinoma epidermóide do colo do útero foi de 30%. Pacientes com captura cervical positiva tiveram 4 vezes mais chance de apresentar captura anal positiva (OR=4; p=0,018). Concluímos haver alta prevalência citológica anal alterada na população estudada. O risco de contaminação anal é significativo nas pacientes com HPV de alto poder oncogênico em cérvice, portanto todas as pacientes com citologia cervical anormal merecem investigação anal, independente da gravidade do laudo citológico

The incidence of anal squamous cell carcinoma has been growing significantly. The main risk factor associated with this injurie is the Human Papilloma Virus (HPV). As studies have shown preclinical stages before the onset of anal cancer. This study aimed to estimate the prevalence of anal cytological abnormalities in patients with abnormal cervical cytology and without macroscopic HPV induced lesions in the anal region. The sample consisted of 70 women with abnormal cervical cytology, seronegative for human immunodeficiency virus (HIV) and without macroscopic anal lesions. Patients answered a questionnaire a were submited to collection of anal and cervical hybrid capture assay and collection of a sample of cervical cytology of two anal samples. Prevalence of anal cytological abnormalities found in patients with cervical cytological abormalities without macroscopic anal lesions was 71.4% and 57.1% of patients showed positive anal capture. Prevalence of positive hybrid capture to oncogenic anal HPV in patients with cervical cytology of atypical squamous cells of undetermined significance (ASC-US) and of low grade squamous intraepithelial lesion (LSIL) was 27.1%. Prevalence in patients with cervical cytology of atypical squamous cells – cannot exclude (ASC-H), high grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma of the uterine cervix in situ or were 30%. Patients with positive cervical capture were 4 times more likely to present positive anal capture (OR=4, p=0.018). In conclusion, we found a high prevalence of anal cytology abnormalities in this population. The risk of anal contamination is significant in patients with oncogenic HPV in cervix, so all patients with abnormal cervical cytology deserve anal investigation, regardless of the severity of cytological report

Citología de impresión conjuntival en pacientes con valores OSDI normales y alterados / Conjunctival impression cytology in patients with normal and impaired OSDI scores

OBJETIVO: Describir la graduación de Nelson y la densidad de células caliciformes en distintas áreas de la superficie ocular usando citología de impresión conjuntival (CIC), en pacientes con valores Ocular Surface Disease Index (OSDI©) normales y alterados. MATERIALES Y MÉTODOS: Los pacientes (n = 166) en evaluación por ojo seco, reclutados entre 2011 y 2012, fueron clasificados según el cuestionario OSDI en 4 categorías (normal y alteradas). Se evaluó citología (CIC con tinción Papanicolaou) aplicando el sistema de graduación de Nelson, con modificaciones en la determinación de la estadificación, y recuento de células caliciformes en zonas nasal, temporal, superior e inferior de la superficie conjuntival. RESULTADOS: El grado de Nelson fue significativamente mayor en pacientes con valores OSDI severos, variando desde 0,86 ± 0,09 en pacientes normales a 1,41 ± 0,14 en OSDI severo (p < 0,01). La densidad de células caliciformes disminuyó desde 497,31 ± 50,07 células por muestra en pacientes normales a 310,24 ± 56,24 células por muestra en pacientes con OSDI severo (p < 0,001). La conjuntiva bulbar no fotoexpuesta presentó un número de células caliciformes significativamente mayor (p < 0,0001) que la zona fotoexpuesta en pacientes con OSDI leve (p < 0,01) y moderado (p < 0,001). CONCLUSIÓN: La densidad de células caliciformes es menor y la clasificación de Nelson es mayor en pacientes con OSDI severo. La densidad de células caliciformes es mayor en la conjuntiva bulbar no fotoexpuesta

PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores. MATERIAL AND METHODS: Patients (n = 166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces. RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41 ± 0.14) compared to normal patients (0.86 ± 0.09) (P<0.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24 ± 56.24 cells per sample) compared with normal subjects (497.31 ± 50.07 cells per sample) (P<0.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<0.01) and moderate (P<0.001) OSDI scores. CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva

Utilidad de la PAAF guiada por TC en el diagnóstico de lesiones mediastínicas / Usefulness CT-guided F.N.A.C. in the Diagnosis of Mediastinal Lesions

ObjetivosEvaluar la validez diagnóstica de la punciónaspiración con aguja fina (PAAF) percutánea en lesiones mediastínicas considerando la biopsia o el seguimiento clínico como patrón de referencia.Pacientes y métodosSe realizó PAAF percutánea guiada por TC a 131 pacientes con lesiones mediastínicas. Se usó un TC helicoidal con cortes de 3–10mm y baja dosis de radiación (40mAs, 120kV). Las muestras fueron examinadas in situ por un citólogo para determinar su validez. Se obtuvo comprobación histológica mediante biopsia o estudio de pieza quirúrgica en 73 pacientes y seguimiento clínico en 50, comparándose los resultados globales y en subgrupos.ResultadosEn 126 pacientes (96,2%) el material fue válido para diagnóstico. Ciento tres lesiones (78,6%) fueron consideradas malignas (62 tumores primarios y 41 metástasis) y 23 (17,6%) benignas. En los 123 pacientes de los que se dispuso de seguimiento clínico o patológico, la PAAF permitió identificar malignidad con una sensibilidad del 95,2% (IC95%: 89,2–97,9%), especificidad 84,2% (IC95%: 62,4–94,5%), valor predictivo positivo 97,1% (IC95%: 91,7–99,0%), valor predictivo negativo 76,2% (IC95%: 54,9–89,4%), razón de verosimilitud positiva 6,03 (IC95%: 2,13–17,05) y exactitud 93,5% (IC95%: 87,7–96,7%). La complicación más frecuente fue el neumotórax (3 casos). La correlación citohistológica fue elevada tanto en las lesiones malignas (kappa 0,641) como en las benignas (kappa 0,607).ConclusionesLa PAAF percutánea guiada por TC es una técnica segura y eficaz para el diagnóstico de masas mediastínicas con alta rentabilidad para la detección de malignidad(AU)

ObjectiveTo evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology (FNAC) for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard.Patients and MethodsCT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions. Helical CT was used with 3–10mm image thickness range and low radiation dose (40mAs, 120kV). Samples were immediately examined by a cytologist to determine if they were representative. Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50.ResultsThe material was satisfactory for diagnosis in 126 patients (95.2 %), in whom 103 lesions (78.6%) were considered malignant (62 primary tumours and 41 metastases) and 23 (17.6%) benign. In the 123 patients with clinical monitoring or pathological diagnosis, using FNAC led to the identification of malignancy with a sensitivity of 95.2 % (95%CI: 89.2–97.9%), specificity 84.2% (95%CI: 62.4–94.5%), positive predictive value 97.1% (95%-CI: 91.7–99.0%), negative predictive value 76.2% (95%CI: 54.9–89.4%), likelihood-ratio positive 6.03 (95%CI: 2.13–17.05) and accuracy 93.5% (95%CI: 87.7–96.7%). Pneumothorax was the most frequent complication (3 cases). There was good agreement between the cytological findings and the histological findings, not only for malignant lesions (kappa coefficient: 0.641) but also for benign (kappa 0.607).ConclusionsCT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses, with a high diagnostic yield for malignancy depicting(AU)

Classificação citológica dos linfomas caninos / Cytological classification of canine lymphomas

Os linfomas estão entre as neoplasias mais frequentes na espécie canina. Do ponto de vista etiológico, epidemiológico, clínico, morfológico e imunofenotípico os linfomas caninos apresentam muitas semelhanças com os linfomas não-Hodgkin humanos e os esquemas de classificação destes têm sido utilizados na espécie canina. O objetivo do presente trabalho foi aplicar aos linfomas caninos as classificações de Kiel, Working Formulation e Fournel-Fleury, et al., (1994) em material colhido pelo método da PAAF (Punção Aspirativa por Agulha Fina). De acordo com a Classificação de Kiel, 61,02% (36 casos) das neoplasias se enquadram como de grau alto 38,98% (23 casos) como de grau baixo. Segundo a Classificação da Working Formulation, 11,86% (sete casos) foram classificados linfomas de grau baixo, 61,02% (36 casos) de grau intermediário e 27,12% (16 casos) de grau alto. Utilizando a classificação proposta por Fournel-Fleury et al. (1994), 38,98% (23 casos) dos animais que apresentaram linfomas de grau baixo e 61,02% (36 casos) de grau intermediário ou alto. Concluindo, a PAAF é um método de diagnóstico que pode ser empregado na classificação dos linfomas caninos. A classificação que mostrou melhores resultados foi a de Kiel, que tem por característica principal a ênfase nos achados citológicos.

Lymphoma is among the most frequent canine neoplasia and share many similarities with human non-Hodgkin’s lymphoma in respect of etiology, epidemiology, clinical, morphological and immunophenotipical aspects. Human classification schemes have been used in canine lymphoma. The aim of this work was apply Kiel, Working Formulation and Fournel-Fleury’s et al. (1994) classification in Fine Needle Aspiration (FNA) cytology matherial. According to Kiel scheme 61.02% (36 cases) were high-grade lymphomas and 38.98% (23 cases) low grade. The Working Formulation, showed 11.86% (7 cases) of low grade, 61.02% (36 cases) intermediary grade and 27.12% (16 cases) high grade. In Fournel-Fleury’s protocol revealed a predominance of high-grade lymphoma, with 61.02% (36 cases) over 38.98% (23 cases) of low grade. In conclusion, FNA can be used as a diagnostic method and in canine lymphoma cytological classification. Kiel’s system showed the best results, once is based on cytologic basis.

Preguntas y respuestas sobre la vacuna contra el virus del papiloma humano / Questions and answers on human papilloma virus vaccine

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Citología peritoneal positiva posthisteroscopia en los estadios iniciales del carcinoma de endometrio: azar o realidad / Positive peritoneal cytology post hysteroscopy in the initial stages of endometrial carcinoma: chance or fact

El adenocarcinoma de endometrio es la neoplasia ginecológica más frecuente. La histeroscopia es la prueba de referencia en el diagnóstico de la enfermedad endometrial. Se determinará la relación entre la citología peritoneal positiva y la histeroscopia en estadios precoces del carcinoma de endometrio, mediante un estudio retrospectivo. Sólo en 2 casos se obtuvo una citología peritoneal positiva (2,1%). Hay múltiples factores que pueden incrementar el número de citologías positivas, aunque la positividad en estadios precoces no parece tener un papel definitivo (AU)

Endometrial carcinoma is the most common gynaecological tumour. Hysteroscopy is the 'gold standard' in the diagnosis of endometrial pathology. We are going to determine the relationship between positive peritoneal cytology and endometrial carcinoma with a retrospective study. Peritoneal cytology was positive in only two cases (2.1%). Many factors exist which may increase the number of positive cytology, although being positive in the early stages does not seem to have a definitive role (AU)

La longitud vaginal: análisis multivariante / Vaginal length: a multivariable analysis

Introducción y objetivo. En una serie de 2.577 mujeres de entre 12 y 90 años, media de 47,5 años, se midió la longitud vaginal con un sistema estándar. Con un estudio prospectivo durante un año, el objetivo fue hacer un análisis multivariante para saber de qué variables depende la longitud vaginal. Las pacientes pertenecían a tres consultas, dos de ginecología general y una de menopausia. La medida de la longitud vaginal se realizó como parte del acto exploratorio y antes de la toma de muestras de citología cervicovaginal. Resultados. Hubo 524 nuligestas (20,33%), 131 vírgenes (5,08%), 293 histerectomizadas (11,36%) y 28 con prolapso uterino (1,08%). La paridad media fue de 1,83 (0-11). El peso osciló entre 41 y 180 kg, media de 66,4 kg. La talla osciló entre 1,30 y 1,80 m, media de 1,58 m. El IMC medio fue de 26,42 (entre 15,27 y 70,31). El 55,5% de las mujeres tenía algún grado de obesidad, y el 1,51% tenía obesidad mórbida. La longitud vaginal media fue de 10,04 cm (entre 5 y 16 cm). Conclusiones. 1. Por la comparación de medias intragrupo la longitud vaginal depende de: no ser virgen (actividad sexual), gestaciones-paridad, no estar histerectomizada y no presentar prolapso, de forma muy significativa, p < 0,001. 2. Por el modelo de regresión logística obtenido, la significación estadística es p < 0,000 para las variables: virginidad, histerectomía, prolapso, edad e IMC (AU)

Introduction and objective. In a series of 2577 women, age range 12-90 years and an average age of 47.5 years, vaginal length was measured by the author with a systematic standard in one year prospective study (2003); the objective was to make a multivariable analysis to know on which variables vaginal length depends. The patients belonged to three different clinics, two of general gynaecology and one of menopause. Measurement of vaginal length was performed as part of the routine examination, before cervical and vaginal samples were taken. Results. There were 524 nulligravids (20.33%), 131 virgins (5.08%), 293 women who had previous hysterectomy (11.36%), and 28 uterine prolapse (1.08%). Weight range was 41-180 kg, mean 66.4 kg. Height range was 1.30-1.80 m mean 1.58 m. Mean body mass index, BMI, was 26.42 (range 15.27-70.31). Some grade of obesity was found in 55.5% of the women, and 1.51% had morbid obesity. Mean vaginal length was 10.04 cm (range 5-16 cm). Conclusions. 1. The comparison of the mean of different groups showed that vaginal length depends on: loss of virginity (sexual activity), gestations-parity, hysterectomy, and uterine prolapse, very significantly, p < 0.001, and 2. by the logistic regression model obtained, the statistical significance is p < 0.000 for the variables: virgin, hysterectomy, prolapse, age and BMI (AU)

Citología peritoneal positiva tras histeroscopia en cáncer de endometrio / Positive peritoneal cytology afte hysteroscopy for endometrial cáncer

Objetivo: Analizar la frecuencia de citologías peritoneales positivas en una serie de 121 pacientes con carcinoma de endometrio diagnosticados por histeroscopia.Sujetos y métodos: Se incluyen 121 pacientes en las que se diagnosticó un cáncer de endometrio utilizando la histeroscopia, realizándose posteriormente laparotomía y lavado peritoneal previo al tratamiento quirúrgico.Resultados: Se obtuvieron en total cinco citologías peritoneales positivas, cuatro de ellas eran casos de carcinoma endometrial en estadios III y IV y uno de ellos estadio 1. La frecuencia de citologías positivas en estadio I fue de 1,07 por 100, que es inferior a lo esperado según las diferentes publicaciones.Conclusión: En nuestra experiencia, el uso de la histeroscopia no aumenta la frecuencia de citologías peritoneales positivas en estadio 1 de carcinoma endometrial (AU)

Evolución clínica del condiloma con y sin tratamiento mujeres de 15-49 años, Hospital Bertha Calderón Roque enero-dicembre 1997-1999

El grupo etáreo mayormente afectado en este estudio fueron mujeres entre los 27-32 años con un 26 porciento continuándoles el grupo de 33 a 38 años con un 25 porciento. La ocupación más representativa fueron las amas de casa con un 70 porciento y un 78 porciento en los grupos tratados y no tratados respecativamente. La mayoría de las mujeres fueron de procedencia urbana con un 72 porciento y 69 porciento en los grupos de tratadas y no tratadas;, la escolaridad que predominó fue la primaria con un 46 porciento y un 32 porciento respectivamente; la mediana de los antecedentes ginecobstétricos en las mujeres con condiloma fueron gesta 4, paridad 3, cesárea 0 y aborto 0; las caracteríticas clínicas que predominaron fue la leucorrea con 67.9 porciento en las tratadas y de un 80.7 porciento de las no tratadas; el método de diagnóstico más frecuente utilizado fue le papanicolaou con un 49 porciento en las tratadas y 82 porciento en las no tratadas; dentro de las patologías asociadas al condiloma no se encontró ninguna patología relevante 33.8 porciento pero también hay que hacer notar que la vaginitis ocupa un segundo lugar de importancia como patología asociada a esta entidad con un 22 porciento; el esquema terapéutico más utilizado fue la crioterapia con un 54.6 porciento y ácido tricloroacetico en un 45.3 porciento; en un 77 porciento de las pacientes con tratamiento y un 44 porciento de las pacientes sin tratammiento no se presentaron complicaciones; las pacientes respectivamente al egresar de consulta externa

Citología endometrial con uterobrush / Endometrial cytology with cytobrush

Evaluar el Cytobrush en relación a la toma de la muestra de citología endometrial y a la calidad de la misma. Cepillado endometrial con uterobrush en pacientes infértiles y perimenopáusicas. Consulta privada de ginecología de la Unidad de Ginecología, Reproducción y Salud Integral, de Valencia, durante los años 1991-1993. Obtención de 76 muestras evaluads (95 por ciento) del total de 80 pacientes seleccionadas por infertilidad o perimenopausia. En todos los extendidos había una gran riqueza celular, donde se destaca la presencia de un 8,75 por ciento de células estromales y glandulares atípicas y 1,25 por ciento de adenocarcinoma. Estas observaciones nos indican que el cepillado endometrial tomado con el uterobrush es un buen método, debido a que la representatividad celular de la muestra estudiada permite hacer el diagnóstico citológico de lesiones precursoras y de neoplasias endometriales, aun en pacientes asintomáticas