Follitropin delta combined with menotropin in patients at risk for poor ovarian response during in vitro fertilization cycles: a prospective controlled clinical study.

BACKGROUND: The maximum daily dose of follitropin delta for ovarian stimulation in the first in vitro fertilization cycle is 12 µg (180 IU), according to the algorithm developed by the manufacturer, and based on patient's ovarian reserve and weight. This study aimed to assess whether 150 IU of menotropin combined with follitropin delta improves the response to stimulation in women with serum antimullerian hormone levels less than 2.1 ng/mL. METHODS: This study involved a prospective intervention group of 44 women who received 12 µg of follitropin delta combined with 150 IU of menotropin from the beginning of stimulation and a retrospective control group of 297 women who received 12 µg of follitropin delta alone during the phase 3 study of this drug. The inclusion and exclusion criteria and other treatment and follow-up protocols in the two groups were similar. The pituitary suppression was achieved by administering a gonadotropin-releasing hormone (GnRH) antagonist. Ovulation triggering with human chorionic gonadotropin or GnRH agonist and the option of transferring fresh embryos or using freeze-all strategy were made according to the risk of developing ovarian hyperstimulation syndrome. RESULTS: Women who received follitropin delta combined with menotropin had higher estradiol levels on trigger day (2150 pg/mL vs. 1373 pg/mL, p < 0.001), more blastocysts (3.1 vs. 2.4, p = 0.003) and more top-quality blastocysts (1.8 vs. 1.3, p = 0.017). No difference was observed in pregnancy, implantation, miscarriage, and live birth rates after the first embryo transfer. The incidence of ovarian hyperstimulation syndrome did not differ between the groups. However, preventive measures for the syndrome were more frequent in the group using both drugs than in the control group (13.6% vs. 0.6%, p < 0.001). CONCLUSIONS: In women with serum antimullerian hormone levels less than 2.1 ng/mL, the administration of 150 IU of menotropin combined with 12 µg of follitropin delta improved the ovarian response, making it a valid therapeutic option in situations where ovulation triggering with a GnRH agonist and freeze-all embryos strategy can be used routinely. TRIAL REGISTRATION: U1111-1247-3260 (Brazilian Register of Clinical Trials, available at https://ensaiosclinicos.gov.br/rg/RBR-2kmyfm ).

Reduced ovarian reserve in patients with adult polymyositis.

Polymyositis (PM) affects female gender during reproductive age; however, there is no study assessing ovarian reserve in these patients to evaluate ovarian reserve markers in PM. Eight female patients with PM (Bohan and Peter criteria, 1975) with aged 18-40 years, followed at our tertiary centre from March 2011 to May 2014, were invited to participate. They were age-matched with 16 healthy individuals (control group). All were evaluated at early follicular phase of menstrual cycle. Follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Müllerian hormone (AMH) serum levels (ELISA) and sonographic antral follicle count (AFC) were determined. PM patients and controls had comparable mean age (31.4 ± 6.5 vs. 30.7 ± 6.2 years, P = 0.946), ethnicity and socioeconomic class (P > 0.05). PM mean age of onset was 27.3 ± 6.5 years and disease duration of 6.5 ± 4.1 years. Menstrual cycles were alike in both groups with a similar frequency of age at menarche, gynaecological age, duration and length of menstrual cycle (P > 0.05). The median serum level of AMH was significantly lower in PM compared to controls [0.7(0.3-3.4) vs. 3.1(1.4-4.0), P = 0.021]. AMH levels ≤1 ng/mL (50 vs. 6.3 %, P = 0.024) and very low AFC (37.5 vs. 6.3 %, P = 0.037) were significantly in PM patients versus controls. The other hormones (FSH, inhibin B and estradiol levels) were similar between both groups (P > 0.05). The present study was the first to identify subclinical ovarian dysfunction in PM patients during reproductive ages. Further study is necessary to assess the possible role of PM-related factors that may influence the ovarian function of these patients.

Septate uterus with cervical duplication and longitudinal vaginal septum.

We present the case of a 19-year-old nulligravida woman with severe dysmenorrhea since menarche; she was found to have a longitudinal vaginal septum, cervical duplication and two endometrial cavities, separated by a complete septum. Diagnosis and management of this unusual Müllerian anomaly are discussed in the context of a literature review.

Septate uterus with cervical duplication and longitudinal vaginal septum: [review] / Útero septado com duplicidade cervical e septo vaginal longitudinal: [revisão]

We present the case of a 19-year-old nulligravida woman with severe dysmenorrhea since menarche; she was found to have a longitudinal vaginal septum, cervical duplication and two endometrial cavities, separated by a complete septum. Diagnosis and management of this unusual Müllerian anomaly are discussed in the context of a literature review.

No presente artigo, relata-se o caso de uma mulher de 19 anos com queixa de dismenorreia intensa desde a menarca. Diagnosticou-se a presença de septo longitudinal vaginal, duplicidade cervical e duas cavidades endometriais, separadas por um septo completo. O diagnóstico e o manejo desta rara malformação Mülleriana são discutidos junto a uma revisão bibliográfica.

Manifestações dermatológicas da síndrome dos ovários policísticos / Dermatologic fi ndings in polycystic ovary syndrome

A síndrome dos ovários policísticos (SOP) é um distúrbio comum que atinge as mulheres na menacme e é caracterizado por anovulação crônica, síndrome androgênica e alteração ultrassonográfica característica. A SOP apresenta uma série de sinais dermatológicos que podem ser confundidos com aspectos fisiológicos da puberdade. O tratamento destas manifestações pode ser feito com drogas antiandrogênicas, além de tratamentos estéticos com laser e medicamentos tópicos.

The polycystic ovary syndrome (PCOS) is a common clinical problem affecting women in premenopausal women, characterized by ovulatory dysfunction, androgenic syndrome and ultrasound alterations. The PCOS presents dermatologic signals that may be diffi cult to diagnose because some features of the syndrome may be physiologic at this age. The treatment can be done with anti-androgenic drugs and esthetic treatments, such as laser and topic drugs.

Resultados maternos e perinatais em pacientes com disfunção sistólica grave / Maternal and perinatal outcome in patients with severe systolic dysfunction

OBJETIVO: O objetivo deste trabalho é avaliar os resultados maternos e perinatais em gestantes com disfunção sistólica grave de ventrículo esquerdo acompanhadas em hospital terciário durante a gestação, parto e puerpério imediato. MÉTODOS: Doze pacientes com disfunção ventricular grave, definida por fração de ejeção <40 por cento em ecocardiograma realizado durante a gestação, foram avaliadas retrospectivamente. Os dados incluíram ocorrência de complicações clínicas e obstétricas, características do parto e resultados neonatais. As complicações clínicas consideradas foram aparecimento ou piora da dispnéia, arritmia, acidente vascular cerebral, tromboembolismo pulmonar, edema agudo de pulmão, parada cardíaca e morte. RESULTADOS: A média da fração de ejeção das pacientes foi 28,9+-6,47 por cento (mediana: 30 por cento). Quatro pacientes iniciaram o pré-natal em classe funcional III e oito com classe I ou II. Dez pacientes apresentaram piora da dispnéia durante a gravidez. A complicação clínica mais comum foi edema agudo de pulmão (Três pacientes). Três das quatro pacientes que iniciaram o pré-natal em classe funcional III apresentaram boa evolução da gravidez; a outra apresentou parto prematuro devido à piora dos sintomas. Houve dois partos vaginais e 10 cesáreas. Dez dos 13 recém-nascidos foram pequenos para idade gestacional. Uma paciente, que já tinha indicação de transplante cardíaco antes da gestação, apresentou descompensação clínica durante a gravidez e evoluiu para edema agudo de pulmão e choque cardiogênico, realizando o transplante dois meses após o parto. Não houve morte materna ou neonatal. CONCLUSÕES: Embora o número de gestações avaliadas tenha sido pequeno, deve-se rever a indicação de abortamento terapêutico em gestantes com disfunção ventricular esquerda grave, uma vez que todas as gestações evoluíram até a viabilidade. Os recém-nascidos destas mães apresentaram grande incidência de restrição do crescimento intra-uterino...

OBJECTIVE: The objective of this study was to evaluate maternal and fetal outcome in patients with severe left ventricle systolic dysfunction followed in a terciary-care hospital. METHODS: We retrospectively evaluated 12 pregnant women with severe systolic dysfunction, defined as a ejection fraction <40 percent. Follow-up data included functional class evaluation, ocurrency of cardiac and obstetric events, labor data and neonatal outcome. Cardiac events were defined as new onset of arrhythmias, stroke, pulmonary thrombosis, pulmonary edema, cardiac arrest, and death. RESULTS: The mean ejection fraction was 28,9±6,47 percent. Four patients were in the NYHA class III, and 8 in class I or II on presentation. Ten patients had deteriorated during pregnancy. The most common cardiac event was pulmonary edema (3 patients). Three of the four patients with class III on presentation had a good evolution during pregnancy, and the other one had preterm delivery due to worsening symptons. There were 2 vaginal espontaneous deliveries and 10 cesarean sections. Small-for-gestational-age birthweigth ocurred in 10 pregnancies. There was no maternal or neonatal death. CONCLUSIONS: Pregnancy in patients with severe left ventricle systolic dysfunction increases the risk of maternal complications and compromises fetal growth. It is important to follow this women in a tertiary-care hospital.

[Maternal and perinatal outcome in patients with severe systolic dysfunction]. / Resultados maternos e perinatais em pacientes com disfunção sistólica grave.

OBJECTIVE: The objective of this study was to evaluate maternal and fetal outcome in patients with severe left ventricle systolic dysfunction followed in a tertiary-care hospital. METHODS: We retrospectively evaluated 12 pregnant women with severe systolic dysfunction, defined as a ejection fraction<40%. Follow-up data included functional class evaluation, occurrence of cardiac and obstetric events, labor data and neonatal outcome. Cardiac events were defined as new onset of arrhythmias, stroke, pulmonary thrombosis, pulmonary edema, cardiac arrest, and death. RESULTS: The mean ejection fraction was 28.9+/-6.47%. Four patients were in the NYHA class III, and 8 in class I or II on presentation. Ten patients had deteriorated during pregnancy. The most common cardiac event was pulmonary edema (3 patients). Three of the four patients with class III on presentation had a good evolution during pregnancy, and the other one had preterm delivery due to worsening symptoms. There were 2 vaginal spontaneous deliveries and 10 cesarean sections. Small-for-gestational-age birthweight occurred in 10 pregnancies. There was no maternal or neonatal death. CONCLUSIONS: Pregnancy in patients with severe left ventricle systolic dysfunction increases the risk of maternal complications and compromises fetal growth. It is important to follow this women in a tertiary-care hospital.

Avaliacao perioperatoria da viabilidade intestinal / Perioperative assessment of the intestinal viability

A determinacao da viabilidade de segmentos intestinais e do grau de isquemia a partir de...

Gestacao e doenca hemorroidaria / Pregnancy and hemorrhoidal disease

Importantes alteracoes fisiologicas ocorrem na mulher no periodo gestacional, sendo que sintomas decorrentes da doenca hemorroidaria frequentemente iniciam-se nesta fase, podendo se agravar durante o parto. Muitas gestantes apresentam constipacao intestinal, fator desencadeante da...

Apendicite epiplóica: relato de três casos e revisäo da literatura / Epiploic appendagitis: related os three cases and literature review

Os apêndices epiplóicos representam saculações de gordura subserosa, localizados na borda antimesenterial do cólon, de funçäo ainda desconhecida. Os primeiros casos de torçäo foram relatados em 1919 (Hunt) mas Lynn batizou-os com o nome de apendicite epiplóica (AE) somente em 1956.Embora infreqüente, acomete homens e mulheres na 3a. e 4a. décadas de vida. A AE primária näo apresenta fatores de risco conhecidos, daí a dificuldade em se estabelecer um diagnóstico. Uma vez que o ceco e o sigmóide säo os locais mais acometidos e a principal manifestaçäo da doença é a dor abdominal localizada aguda, o diagnóstico diferencial deve incluir a apendicite aguda e a diverticulite, já que a AE representa via de regra uma condiçäo benigna auto-limitada

Correlaçäo entre dados antropométricos de doadores de múltiplos órgäos com o peso do pâncreas / Correlation between the antropometric parameters of multiple organ doanors and the pancreas weight

O transplante de ilhotas de Langerhans representa técnica promissora no tratamento do Diabetes mellitus. Dados antropométricos do doador, estäo diretamente relacionados com a quantidade de ilhotas viáveis obtidas após o processamento do pâncreas, o que relaciona-se diretamente com o sucesso do transplante de ilhotas. o objetivo do trabalho é verificar se existe correlaçäo do peso e do IMC de doadores cadáveres com o peso do pâncreas. Para isso foram removidos 35 pâncreas de doadores de múltiplos órgäos e coletou-se os dados antropométricos e epidemiológicos dos doadores, realizando também a pesagem dos pâncreas. Através de índice de correlaçäo de Pearson e do modelo de regressäo linear múltipla - método Stepwise, analisamos a relaçäo entre altura, peso, IMC e idade dos doadores com o peso de seus respectivos pâncreas. Com um índice de correlaçäo de Pearson (CP) de 0,683 (p<0,000), a altura do doador representou a principal variável correlacionada com o peso do pâncreas. Entretanto, o peso com CP igual a 0,682 também foi significativo, com CP praticamente igual a da altura. Concluiu-se que a altura do doador pode ser um dado valorizado na estimativa da quantidade de ilhotas obtida a partir de pâncreas de doadores cadáveres