Fetal reanimation: a case report

A tocolytic treatment is described with the use of terbutaline in a case of cardiotocographic prolonged deceleration of fetal heart rate with successful outcome.Os autores descrevem caso de desaceleração prolongada da freqüência cardíaca fetal, diagnosticada através da cardiotocografia, tratada com sucesso mediante tocólise aguda com terbutalina intravenosa.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Amparo MaternalUNIFESP, EPM, Amparo MaternalSciEL

Preservation of fertility: the importance of providing this possibility to patients with cancer

Universidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUNIFESP, Depto. de GinecologiaSciEL

Endometrium in women with polycystic ovary syndrome during the window of implantation

The human endometrium undergoes to a complex series of prolifertive and secretory changes in each menstrual cycle and displays only a short period of receptivity, known as the window of implantation, necessary for the implantation of the blastocyst in the uterus. The implantation process occurs in a sequential manner, leading to the establishment of pregnancy. Morphofunctional changes during this period may prevent or hinder the implantation. For this reason, the study of the endometrium at this stage is important for the improvement of therapies that may interfere with the mechanisms involved in maternal-embryonic interaction. Several gynecological disorders, including polycystic ovary syndrome (PCOS), are associated with decreased fertility and uterine receptivity. In spite of recent advances in assisted reproduction techniques, allowing the selection of high quality embryos, the implantation rate remains low and has not increased enough in recent decades. This article aims at reviewing the endometrial aspects of the window of implantation in women with polycystic ovary syndrome, focusing mainly on adhesion molecules. For that purpose, we analyzed 105 articles published in journals indexed in PubMed in the last 50 years (up to May 2011). In conclusion, the endometrial receptivity seems to be the major limiting factor for the establishment of pregnancy in a large number of gynecological diseases, including PCOS, and treatment to improve implantation rates is likely to be taken towards this direction.O endométrio humano é submetido a uma complexa série de mudanças proliferativas e secretórias em cada ciclo menstrual e exibe somente pequeno período de receptividade, conhecido como janela de implantação, necessário para a nidação do blastocisto no útero. O processo da implantação ocorre de forma sequencial, levando ao estabelecimento da gravidez. Alterações morfofuncionais durante este período podem impedir ou dificultar a implantação. Por este motivo, o estudo do endométrio nesta fase é importante para o aprimoramento de terapias que possam interferir nos mecanismos envolvidos na interção materno-embrionária. Várias doenças ginecológicas, incluindo a síndrome dos ovários policísticos (SOP), estão associadas à diminuição da fecundidade e da receptividade uterinas. Apesar de recentes avanços nas técnicas de reprodução assistida, permitindo a seleção de embriões de alta qualidade, a taxa de implantação continua baixa e não tem aumentado suficientemente nas últimas décadas. O presente artigo tem como objetivo revisar os aspectos endometriais da janela de implantação em mulheres com a síndrome dos ovários policísticos, focando especialmente as moléculas de adesão. Para tanto, nos valemos da análise de 105 artigos publicados em revistas indexadas no PUBMED nos últimos 50 anos (até maio de 2011). Como conclusão, a receptividade endometrial parece ser o maior fator limitante no estabelecimento da gestação em grande número de doenças ginecológicas, incluindo a SOP, e o tratamento para melhorar as taxas de implantação possivelmente será nessa direção.Universidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUniversidade Federal do PiauíUniversidade de São Paulo Faculdade de MedicinaUNIFESP Departamento de MorfologiaFMUSP Departamento de Obstetrícia e GinecologiaUNIFESP, Depto. de GinecologiaUNIFESP, Depto. de MorfologiaSciEL

Melatonin action on luteal - granulosa cells in women with marital infertility undergoing in vitro fertilization

Introduction of the subject: Melatonin is a hormone related to the light-dark cycle and it plays an influential role in the reproductive system. In humans, researchers have shown there is three times more melatonin in follicular fluid than in the blood flow, suggesting the influence of the hormone on follicular maturation. However, little is known about melatonin action on granulosa cells in women with infertility, especially the molecular mechanisms involved. We are, therefore, conducting this study to evaluate melatonin action pathways in granulosa cells in the ovaries of women with infertility. To achieve our aim, we will use molecular biology, involving diverse signaling pathways, such as angiogenesis. Objective(s): to analyze melatonin action on luteal - granulosa cells in women with marital infertility undergoing in vitro fertilization. Methodology: For this, 68 patients, aged between 20 and 35 years, attended at the Human Reproduction Sector of the Federal University of São Paulo, were submitted to in vitro fertilization treatment. After all preparatory procedures were performed, luteal granulosa cells were removed and routed to the cell culture. The cells were divided into four groups: a) control; b) 0.1 μM melatonin; c) 1 μM melatonin; d) melatonin at 10μM. After a period of 10 days, the cells were trypsinized for extraction of the total RNA and later analysis of the gene expression by Real Time PCR of the angiogenesis signaling pathway. Results: Our data evaluated 96 genes, which are related to the angiogenesis pathway. The results of transcriptional expression showed important genes involved in this pathway that are hypo or hyperexpressed after treatment with melatonin. The main hyperexpressed genes were: fibroblast growth factor 1 (FGF1) genes; interleukin 1-beta (IL1B); receptor tyrosine kinase (VEGFR-2); folliculogenesis regulating genes (TGFB1). They act in the dynamics of follicular growth. On the other hand, the genes inducing factor 1-alpha (HIF1A), fibroblast growth factor 2 (FGF2), insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGFA) melatonin decreased its expression. Discussion and conclusion of the results: It is concluded that melatonin in high concentration (above 1 μM) may have dual function in increasing the expression of some growth factors and cytokines, in the decrease of other genes and mechanism of physiological compensation and also modulates negative angiogenesis, mainly in the dose (10 uM) of granulosa cells from women submitted to in vitro fertilization. Perhaps this fact is important for adequate follicular growth, avoiding excessive growth, which could turn the follicle into cyst, making ovulation difficult.Keywords: Melatonin; Granulosa cells; Women; Marital infertility; In vitro fertilization

Treatment of left main coronary artery lesion after late thoracic radiotherapy

A prevenção de complicações cardiovasculares tardias após radioterapia (RT) para tratamento de um tumor maligno é um desafio. Relatamos o caso de um jovem paciente com linfoma de Hodgkin submetido a tratamento com RT que desenvolveu doença cardíaca isquêmica no seguimento, embora não apresentasse fatores de risco cardiovasculares. Concluímos que pacientes submetidos a RT que apresentam dor torácica deveriam ser criteriosamente avaliados em relação à doença arterial coronariana.Prevention of late cardiovascular complications after radiation therapy (RT) for treatment of a malignant tumor is challenging. We report the case of a young male patient with Hodgkin's lymphoma treated with RT, who developed ischemic heart disease during follow-up, although he had no cardiovascular risk factors. We conclude that patients undergoing RT who experience chest pain should be fully investigated for coronary artery disease

Morphological aspects of the squamocolumnar junction of rats in permanent estrus treated with an association of estrogen and glucocorticoid

PURPOSE: to evaluate the effects of estradiol benzoate associated with dexamethasone on the squamocolumnar junction (SCJ) of rats in permanent estrus (PE) and then ovariectomized (Ovx). METHODS: thirty female rats were divided into six groups of five animals each: PhEG rats in physiological estrus (PhE) treated with propylene glycol (vehicle); OVXG rats in PhE, Ovx and treated with vehicle; PEG - rats in PE treated with vehicle; PEOVXG rats in PE, Ovx and treated with vehicle; ESTRG rats in PE, Ovx and treated with 10 mg per day benzoate of estradiol, and DEXAG in PE, Ovx and treated with 10 mg per day estradiol benzoate associated with 0.8 mg dexamethasone. PE induction was performed with 1.25 mg testosterone propionate per animal per day after birth. After 90 days, rats in the OVXG, EPOVXG, ESTRG, and DEXAG groups were ovariectomized. After 21 days of castration, all animals received the corresponding treatment for five days. At the end of the experiment, all animals were sacrificed and the uteri removed for histological routine. RESULTS: the borders of the SCJ in the PEG were irregular and not clearly delineated, with many buds towards the direction of the lamina propria as well as a reduction in the leukocyte number compared to the PhEG. The SCJ of the OVXG and PEOVXG was not very visible, with cubical epithelium on the endometrial side and with reduction in the layers of squamous epithelium due to stromal atrophy. The SCJ in the ESTRG was more developed than in the OVXG and PEOVXG, but it was similar to that of the PEG, having unclear borders. In contrast, the SCJ of the DEXAG was well-delineated and similar to the PhEG. CONCLUSION: our data suggest that estrogen associated with dexamethasone may be important for remodeling SCJ morphology in female rats with previously induced permanent estrus and subsequent ovariectomy.OBJETIVO: avaliar o efeito da associação de dexametasona com estrogênio sobre a junção escamo-colunar (JEC) de ratas em estro permanente e ovariectomizadas (Ovx). MÉTODOS: trinta ratas foram divididas em seis grupos com cinco animais cada: GEF em estro fisiológico, tendo recebido propilenoglicol (veículo); GOVX em estro fisiológico com ovariectomia e tratadas com o veículo; GEP em estro permanente (EP); GEPOVX em EP, Ovx e tratadas com veículo; GESTR - em EP, Ovx e tratadas com 10 mg/dia de benzoato de estradiol e GDEXAR em EP, Ovx e tratadas com 10 mg/dia de benzoato de estradiol e 0,8 mg/dia de dexametasona. O EP foi induzido com 1,25 mg/animal de propionato de testosterona logo após o nascimento. Após 90 dias, as ratas foram ovariectomizadas nos grupos GOVX, GEPOVX, GESTR e GDEXAR. Após 21 dias de castração, os animais foram tratados por cinco dias consecutivos. No final do experimento, todos os animais foram sacrificados e o útero removido para rotina histológica. RESULTADOS: a JEC do GEP tinha limites irregulares e pouco nítidos, com vários brotamentos em direção da lâmina própria, bem como redução do número de leucócitos comparado a GEF. A JEC do GOVX e do GEPOVX se mostrou pouco nítida, com epitélio cúbico na parte endometrial e diminuição das camadas do epitélio escamoso, com atrofia estromal. No GESTR, a JEC apresentou-se bem mais desenvolvida que nos grupos GOVX e GEPOVX, mas assemelhando-se mais ao GEP devido aos limites pouco nítidos e aumento dos brotamentos. Já no GDEXAR, a JEC foi bem delimitada, se aproximando do aspecto do GEF. CONCLUSÃO: nossos dados sugerem que a dexametasona associada ao estrogênio seria importante na restauração da morfologia normal da JEC em ratas que foram previamente induzidas a estro permanente e subseqüentemente submetidas a castração.Universidade Federal de São Paulo (UNIFESP) Escolsa Paulista de Medicina Departamento de MorfologiaUniversidade Federal de São Paulo (UNIFESP) Escolsa Paulista de Medicina Departamento de GinecologiaUNIFESP, Escolsa Paulista de Medicina Depto. de MorfologiaUNIFESP, Escolsa Paulista de Medicina Depto. de GinecologiaSciEL

Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids

Uterine leiomyoma is the most frequently occurring solid pelvic tumor in women during the reproductive period. Magnetic resonance-guided high-intensity focused ultrasound is a promising technique for decreasing menorrhagia and dysmenorrhea in symptomatic women. The aim of this study is to review the role of Magnetic resonance-guided high-intensity focused ultrasound in the treatment of uterine fibroids in symptomatic patients. We performed a review of the MEDLINE and Cochrane databases up to April 2016. The analysis and data collection were performed using the following keywords: Leiomyoma, High-Intensity Focused Ultrasound Ablation, Ultrasonography, Magnetic Resonance Imaging, Menorrhagia. Two reviewers independently performed a quality assessment; when there was a disagreement, a third reviewer was consulted. Nineteen studies of Magnetic resonance-guided high-intensity focused ultrasound-treated fibroid patients were selected. The data indicated that tumor size was reduced and that symptoms were improved after treatment. There were few adverse effects, and they were not severe. Some studies have reported that in some cases, additional sessions of Magnetic resonance-guided high-intensity focused ultrasound or other interventions, such as myomectomy, uterine artery embolization or even hysterectomy, were necessary. This review suggests that Magnetic resonance-guided high-intensity focused ultrasound is a safe and effective technique. However, additional evidence from future studies will be required before the technique can be recommended as an alternative treatment for fibroids

A (RE)ORGANIZAÇÃO DO CAPITAL AGROINDUSTRIAL CANAVIEIRO. O CASO DO OESTE PAULISTA

 O objetivo deste texto é destacar o processo de territorialização do capital agroindustrial sucroalcooleiro no Pontal do Paranapanema e Alta Paulista, destacando nesse contexto o papel do Proálcool na consubstanciação das unidades produtivas na referida área de estudo