Diclofenac versus a combination of hyoscine and diclofenac for outpatient hysteroscopy: A placebo controlled randomized clinical trial.

OBJECTIVE: to compare the effect of administering diclofenac sodium and/or oral hyoscine in pain perception during and after outpatient diagnostic hysteroscopy without anesthesia. STUDY DESIGN: a randomized, double-blind placebo-controlled clinical trial was performed in an University Hospital. We included 217 patients submitted to office hysteroscopy for the following indications: diagnosis of abnormal uterine bleeding, endometrial polyps, submucous myomas, infertility and recurrent miscarriage. Patients were allocated into 3 groups: (Group 1) placebo, (Group 2) diclofenac sodium 50 mg and (Group 3) diclofenac sodium 50 mg plus Hyoscine-N-Butylbromide 10 mg. The primary outcome was the visual analogue score immediately after the procedure. The secondary outcomes included Likert acceptance scale, the need for extra analgesia after the procedure, need to stay in the observation room and the occurrence of vagal symptoms. RESULTS: Groups were similar according to age, color, age of menarche, gravity, c-section, abortion, presence of pelvic pain, presence of uterine scar, height and body mass index. Patients in all three groups demonstrated similar visual pain scores when submitted to office hysteroscopy (Group 1: 4.18 ± 3.1, Group 2: 4.68 ± 2.9, group 3: 4.45 ± 2.9, P = 0.59). Moreover, patients presented high acceptance scores of the procedure, similar between groups. We performed a subgroup analysis in patients in treatment for chronic pelvic pain and, in this subgroup, prior medication with diclofenac sodium isolated or associated with hyoscine were both effective in decreasing pain levels when compared to placebo (Group 1: 6.0 ± 1.9, Group 2: 3.6 ± 2.1, group 3: 4.2 ± 1.5, P = 0.04). CONCLUSION(S): Office hysteroscopy is a well tolerated procedure and prior use of analgesic medication was not effective in decreasing pain. In selected patients with chronic pelvic pain the use prior analgesic medication may be beneficial.

Correlations among algometry, the visual analogue scale, and the numeric rating scale to assess chronic pelvic pain in women.

OBJECTIVE: To investigate the correlation between the numerical rating scale, visual analogue scale, and pressure threshold by algometry in women with chronic pelvic pain. STUDY DESIGN: This was a cross-sectional study. We included 47 patients with chronic pelvic pain. All subjects underwent a pain assessment that used three different methods and were divided according to the cause of pain (endometriosis versus non-endometriosis). Moreover, we assessed the agreement between the scales (visual, analogue and algometry) using the intraclass correlation coefficient (ICC). RESULTS: The ICC for the numeric rating scale and the visual analogue scale regarding pain (0.992), dysmenorrhea (1.00) and dyspareunia (0.996) were strong. The agreement between the scales was excellent (p ≤0.01). The correlation between algometry and the scales showed a moderate and inverse association, and this correlation was statistically significant: as the scores on the numeric rating scale and the visual analogue scale regarding dyspareunia increased, the algometry thresholds decreased. CONCLUSIONS: The assessment of women with chronic pelvic pain should combine pressure algometry and the numeric rating scale or the visual analogue scale, because of their inverse correlations and satisfactory reliability and sensitivity, to make pain assessment less subjective and more accurate.

Serum prolactin and CA-125 levels as biomarkers of peritoneal endometriosis.

BACKGROUND/AIMS: To evaluate serum prolactin and CA-125 levels as biomarkers for the diagnosis of peritoneal endometriosis. METHODS: A prospective study was performed. Blood samples were drawn from a peripheral vein during the secretory phase of the menstrual cycle (day 19-21 prior to the surgery) to analyze through relative operating characteristic curve the serum prolactin and CA-125 levels for diagnosis of peritoneal endometriosis. The study was performed with 97 participants, 63 women with peritoneal endometriosis and 34 healthy women. RESULTS: The sensitivity and specificity of peritoneal endometriosis diagnosis were equivalent for prolactin (21 and 99%) and for CA-125 (27 and 97%; p = 0.58). These two markers were used in a parallel test utilizing the usual cutoff (prolactin 20.0 ng/ml and CA-125 35 U/I). The sensitivity and specificity were 44 and 99%. However, by utilizing the best cutoff (prolactin 14.8 ng/ml and for CA-125 19.8 U/I), sensitivity, specificity and negative predictive value were 77, 88 and 97%, respectively. CONCLUSION: Serum CA-125 and prolactin levels assessed together, and considering the cutoff for CA-125 (19.9 U/I) and prolactin (14.8 ng/ml), allow the diagnosis of peritoneal endometriosis with acceptable sensitivity and specificity (77 and 88%) and a high negative predictive value (97%).

There is no complete linkage between the polymorphisms N680S and T307A of the follicular stimulating hormone receptor gene in fertile women.

PURPOSE: We conducted a cross-sectional study to evaluate the linkage of FSHR T307A and N680S in a group of fertile women. METHODS: Peripheral blood was obtained from 51 fertile women. DNA extraction and isolation were performed. For the detection of the T307A polymorphism a set of primers (5_-TCTGAGCTTCATCCAATTTGCA-3_and 5_-GGGAAAGAGGGCA GCTGCAA-3) was used and then the product was further amplified by a second PCR-RFLP using another set of primers (5_-CAAATCTATTTTAAGGCAAGAAGTTGATTATATGCCTCAG-3_and 5_-GTAGATTCCAATGCAGA GATCA-3). For the N680S polymorphism the primers (5_-TTTGTGGTCATCTGTGGCTGC-3_ and 5_-CAAAGGCAAGGACTGAATT ATC ATT-3_) were used. Statistical analysis for the association between the polymorphisms was performed by the Spearman test. RESULTS: We calculated the association between the homozygosis at codon 307 and at codon 680 both for T/T-S/S and A/A-N/N. A significant association between the genotypic results at codon 680 with those at codon 307 was found (r = 0.6363, P = 0.001). However, a complete linkage between these two polymorphisms was rejected as there were 12 patients with discordant results from the expected A-N/T-S at codons 307 and 680, respectively. CONCLUSION: The current data demonstrated an association but failed to demonstrate a complete linkage between these two polymorphisms.

Histerossalpingografia e imunofluorescência indireta pra clamídia no dignóstico do fator tubo-peritoneal em pacientes inférteis / Hysterosalpingography and chlamydia trachomatis antibody titers in diagnosis tubal disease in infertility patients

Foi realizado um estudo retrospectivo que avaliou a imunofluorescência indireta para clamídia e a histerossalpingografia (HSG), em relaçao à laparoscopia, no diagnóstico de infertilidade de causa tubo-peritoneal em pacientes inférteis. Foram selecionados 93 casos que realizaram HSG, imunofluorescência indireta para clamídia ou laparoscopia em nosso Serviço. Dezessete pacientes possuíam dados de HSG e laparoscopia, e 13 de imunofluorescência indireta para clamídia e laparoscopia. Na comparaçao, a HSG apresentou: sensibilidade de 100 por cento, especificidade de 18 por cento, valor preditivo positivo de 40 por cento e valor preditivo negativo de 100 por cento. A imunofluorescência indireta para clamídia apressentou resultados inferiores à HSG com uma sensibilidade de 60 por cento, especificidade de 38 por cento, valor preditivo positivo de 38 por cento e valor preditivo negativo de 60 por cento. As diferenças nao foram estatisticamente significativas, para o teste exato de Fisher com a<0,05. A HSG parece ser superior à imunofluorescência indireta para clamídia na avaliaçao de fator tubo-peritoneal. No entanto, nenhum dos exames contém as características ideais de exame de triagem. Ambos possuem seu papel na investigaçao inicial e, em associaçao, sao capazes de realizar melhor rastreamento de pacientes inférteis que devem ser submetidos a laparoscopia para a pesquisa de fator anatômico, do que isoladamente.

Memory deficits after recovery of transient forebrain ischemia in rats: a preliminary report

Transient forebrain ischemia causes delayed cell death of vulnerable neuronal populations, in rodents, primates and man, mainly in the pyramidal CA1 sector of the hippocampus. Lesions involving hippocampal formation are of great interest due to its recognized importance in information processing. In a series of experiments, we investigated the performance of rats after recovery of an ischemic episode, in two avoidance tasks and in one appetitive task with a spatial component. Wistar rats were subjected to transient forebrain ischemia (ISC) through electrocauterization of vertebral arteries and 20 min occlusion of common carotids. One group was tested 21 to 28 days after ISC, and another 7 months after the episode, along with agematched controls. Ischemic animals tested in the early phase of recovery showed impairment of both inhibitory and active avoidance tasks, as well as the water-finding task. However, ischemic rats tested after long-term recovery exhibited avoidance deficits in the active, but not in the inhibitory task, and presented higher latencies of water-finding. Considering that the pattern of cognitive impairment after short and long recovery periods is different, we suggest that neuronal circuitry involved in the tasks studied may be influenced by the probable reorganization of hippocampal synapses after recovery from an ischemic episode.