Effects of Insulin Resistance on Myocardial Blood Flow and Arterial Peripheral Circulation in Patients with Polycystic Ovary Syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is associated with increased risk for cardiovascular disease. We sought to evaluate the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with PCOS. METHODS: We studied 55 women (28 with PCOS without IR, 18 with PCOS and IR and 11 normal controls) who underwent laboratorial analysis, high-resolution vascular ultrasound and real time myocardial contrast echocardiography (RTMCE). Intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were evaluated by vascular ultrasound. The replenishment velocity (ß), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR) were determined by quantitative dipyridamole stress RTMCE. RESULTS: ß reserve in group PCOS + IR was lower than control (2.34 ± 0.55 vs. 3.60 ± 0.6; P < 0.001) and than PCOS without IR (2.34 ± 0.55 vs. 3.17 ± 0.65; P < 0.001). MBFR in patients with PCOS without IR did not differ from those of control (4.59 ± 1.59 vs. 5.30 ± 1.64; P = 0.22) or from patients with PCOS + IR (4.59 ± 1.59 vs. 3.70 ± 1.47; P = 0.07). When comparing with control group, patients with PCOS + IR had lower MBFR (5.30 ± 1.64 vs. 3.70 ± 1.47; P = 0.01). No significant differences were found between control, PCOS without IR and PCOS + IR for FMD (0.18 ± 0.05, 0.15 ± 0.04 and 0.13 ± 0.07; P =NS) or IMT (0.48 ± 0.05, 0.47 ± 0.05 and 0.49 ± 0.07; P = NS). CONCLUSION: Women with PCOS and IR had depressed ß and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed isolated depression in ß reserve, probably an earlier marker of myocardial flow abnormality.

Myeloperoxidases and polycystic ovary syndrome.

New biological markers are emerging trying to identify earlier cardiovascular high risk subjects. Myeloperoxidases have been involved in the role of atherosclerosis process, by the beginning of the endothelial dysfunction up to the plaque rupture and clinical manifestation, and it has been demonstrated that this enzyme has also a prognostic value. We aimed to assess myeloperoxidases levels in patients with polycystic ovary syndrome (PCOS) with insulin resistance (IR), considering that these women represent a high risk group for cardiovascular disease. We developed a transversal study, comprising 26 patients with PCOS and IR and 30 controls (PCOS without IR). IR was considered with HOMA-IR ≥3.0. IR absence was considered when HOMA-IR <3.0, triglycerides <200, BMI <28.7, and BMI<27.8 in patients with familial history of type 2 diabetes. All patients went through anamnesis, physical examination, transvaginal ultrasound, and blood samples. IR PCOS patients had higher levels of myeloperoxidase (22.3 × 18.1, p = 0.047), and also higher BMI. Myeloperoxidase levels correlated directly with insulin. In conclusion, IR PCOS young patients have higher myeloperoxidase levels.

Androgen deficiency in women.

The evidence suggest that androgen deficiency in women induces sexual dysfunction as its main clinical manifestation, in particular reduced libido. However, other factors may be involved in the genesis of this disease, such as interpersonal relationships, social stressors, physical inactivity and the partner. The prevalence of sexual problems among women ranges from 9 to 43% and, recently, many studies have reported that androgens are beneficial not only for women's sexual function, but also for mood disorders and vasomotor symptoms. This is why physicians should include androgen deficiency syndrome in their differential diagnosis, even in women with adequate estrogen levels. Our objective was to present the practical aspects of this disease, emphasizing diagnosis and focusing on treatment. This review searched PUBMED for publications from the last 51 years, up to May 2010, including consensus statements and expert opinions and identified 105 articles. We concluded that the androgen deficiency syndrome in women is overlooked in clinical practice. There is no consensus in the literature regarding diagnosis or treatment, including choice of drug, route of administration and time of application.

Findings in patients with postmenstrual spotting with prior cesarean section.

STUDY OBJECTIVE: Throughout the years, patients previously submitted to C-sections may have abnormal uterine bleeding (AUB) of the post-menstrual spotting type. This symptom has been correlated to an anatomical defect on the anterior uterine wall. The objective of the present investigation was to assess the hysteroscopy findings of women at reproductive age, previously submitted to cesarean sections and complaining of post-menstrual spotting, stressing the diagnosis of isthmocele. DESIGN: Prospective study (Canadian Task Force II). SETTING: State public hospital-Department of Gynecological Endoscopy. PATIENTS: Forty-three patients at reproductive age previously submitted to one or more cesarean sections, complaining of AUB of the post-menstrual spotting type, were submitted to diagnostic hysteroscopy in order to assess the presence of anterior uterine wall isthmocele. INTERVENTIONS: Hysteroscopic diagnoses. MEASUREMENTS AND MAIN RESULTS: The mean number of previous C-sections was 2, the average time of post-menstrual spotting observation was 6 years and the mean duration of each episode was 6 days. The hysteroscopic diagnosis of isthmocele was conclusive in 38 patients (88.37%). CONCLUSION: Patients with previous C-sections complaining of postmenstrual spotting type of AUB have a high prevalence of isthmocele, and this condition is likely diagnosed through diagnostic hysteroscopy.

Deficiência androgênica na mulher / Androgen deficiency in women

As evidências sugerem que a deficiência androgênica na mulher exibe como principal manifestação clínica a disfunção sexual, especialmente a queda da libido. Entretanto, outros fatores podem também estar implicados na gênese da disfunção sexual, como o relacionamento interpessoal, os estressores sociais, o sedentarismo e o próprio fator masculino. A prevalência da disfunção sexual feminina oscila entre 9 por cento e 43 por cento e recentemente muitos estudos têm mostrado que a reposição com androgênios não só melhora o desempenho sexual, mas também os distúrbios do humor e sintomas vasomotores. Por isso, o profissional de saúde deve sempre incluir no diagnóstico diferencial da disfunção sexual a Síndrome de Deficiência Androgênica, mesmo em mulheres com concentrações séricas normais de estrogênios. O presente artigo tem como objetivo revisar os aspectos práticos da Síndrome de Deficiência Androgênica, enfocando especialmente o diagnóstico e tratamento. Para tanto, nos valemos da análise de 105 artigos publicados em revistas indexadas no PUBMED nos últimos 51 anos (até maio de 2010), incluindo consensos e opiniões de especialistas. Como conclusão, a Síndrome de Deficiência Androgênica na mulher é negligenciada, existindo ainda muitas controvérsias quanto ao seu diagnóstico e terapêutica, especialmente no tocante à escolha do androgênio, a via de administração e o tempo de duração de uso.

The evidences suggest that androgen deficiency in women induces sexual dysfunction as the main clinical manifestation, especially reduction of libido. However, other factors may be involved in the disease genesis, such as interpersonal relationships, social stressors, sedentarism and the partner. Prevalence of sexual problems among women ranges from nine to 43 percent and, recently, many studies have reported that androgens are beneficial not only for the sexual function of women, but for mood disorders and vasomotor symptoms. That is why the physician should include androgen deficiency syndrome as differential diagnosis, even in women with adequate levels of estrogen. Our goal was to present practical aspects of this disease, emphasizing diagnosis and focusing on treatment. This survey covered all the publications indexed in PUBMED in the last 51 years ending May 2010, including consensus and expert opinions; 105 articles were identified. We conclude that the syndrome of androgen deficiency in women is overlooked in clinical practice. There is controversy in literature regarding diagnosis and treatment including choice of drug, route of administration and time of application.

Cicatriz da cesariana: implicações ginecológics e aspectos atuais / Cesarean scar: gynecologic implications and current aspects

A cicatriz de cesariana como causa de morbidades ginecológicas, algo até pouco tempo ignorado pelos ginecologistas, é atualmente foco de importante discussão. O aumento atual da via abdominal para o parto faz desse tópico um assunto de extrema importância no cotidiano médico. O sangramento pós-menstrual sem causa aparente tem, na maioria das vezes, a cicatriz de cesariana como fator causal. Pode ocorrer, também, o comprometimento da fertilidade ou pela dificuldade de implantação embrionária ou pela piora da qualidade do muco cervical, em razão do sangramento uterino anormal. Discute-se, hoje em dia, qual o melhor método para o diagnóstico das alterações uterinas decorrentes da cicatriz de cesárea. A investigação pode ser feita inicialmente pela utrassonografia transvaginal, mas a histeroscopia tem maior acurácia além de permitir o tratamento específico. Em todas as situações, a investigação e o bom planejamento terapêutico só podem ser feitos quando o ginecologista conhece bem essa afecção.

The cesarean scar as cause of gynecological morbity, fact that used to be ignored by gynecologists, is the subject of an important discussion nowadays. The current increase in the number of abdominal delivery makes this subject a constant in our daily pratice. The post-menstrual uterine bleeding without an apparent cause has, in the majority of cases, the cesarean scar as only predisponent factor. There might also be infertility due to the difficulty of embryonic implantation or to the presence of the blood making the cervical mucus hostile. Currently, there is a discussion on the best method for the diagnosis of uterine alterations due to cesarean scar. The investigation may be initially accomplished by means of transvaginal ultrasound, but only the hysteroscopy may be precise in the diagnosis and allow specific treatment. In all situations, the investigation and adequate therapeutic planning can only be made if the gynecologist has ample knowledge on this pathology.

Primary hypothyroidism presenting as ovarian tumor and precocious puberty in a prepubertal girl.

We report a case of a prepubertal girl with juvenile primary hypothyroidism presenting as ovarian cysts and precocious puberty. The 7-year-old female was referred to our clinic because of a pelvic/abdominal mass and vaginal bleeding. Besides these findings, on physical examination we noticed the thyroid gland globally increased and the presence of secondary sexual characteristics. Based upon the clinical profile and investigations, the patient was diagnosed with juvenile primary hypothyroidism due to autoimmune thyroiditis. The cysts and precocious puberty resolved spontaneously after the simple replacement of thyroid hormone. It is important to bear in mind hypothyroidism in cases of girls presenting ovarian cysts and precocious puberty in order to avoid unnecessary surgery on the ovaries.

Estudo dos efeitos da fluoxetina e da venlafaxina no comportamento alimentar compulsivo do tipo “binge” em ratos / Study of fluxetine and venlafaxine effects in binge-eating in rats

Objetivo: Avaliar a eficácia da fluoxetina e venlafaxina no tratamento do comportamento alimentar compulsivo tipo ‘binge” induzido por restrição de espaço, em ratos. Material e método: Foram utilizados 120 ratos, subdivididos em grupos de acordo com a droga utilizada (controle, fluoxetina ou venlafaxina), os tipos de alimentação (dieta livre ou regrada) e gaiolas utilizadas (tamanho padrão ou de espaço restrito) . Resultados: Os ratos mostraram hiperfagia rebote quando foram submetidos à dieta restrita (2 horas/dia por 7 dias). A hiperfagia foi aumentada quando os ratos foram colocados na gaiola de espaço restrito, tendo sua mobilidade diminuída. Apenas o grupo em que foi administrada venlafaxina apresentou diminuição do “binge” pela restrição de espaço. Conclusão: O tratamento com fluoxetina foi incapaz de alterar o comportamento do tipo “binge” induzido em ratos, já a venlafaxina, sob as mesmas condições, reduziu este comportamento.

Background: studies have suggested that people who suffer from bulimia nervosa show signs of reduced serotonin activity, which may be related to binge-eating. Objective: to evaluate fluoxetine and venlafaxine efficacy in treatment of binge eating induced byspace restriction in rats. Methods and materials: Were studied 120 rats, divided according to the administrated drug (control, fluoxetine or venlafaxine), feeding types (free feeding or scheduled feeding) and cages (home cages or space-restricted cages). Results: the rats showed rebound hyperphagic state when they were released from scheduled feeding. The hyperphagia was further enhancedwhen they were put in a space-estricted cage where their mobility was restricted. Only the group that received venlafaxine showed decrease in binge eating induced by space restriction. Conclusion: the treatment with fluoxetine was enable to change the binge eating in rats, however venlafaxine, at same conditions, reduced this behaviour.

Hiperplasia primária unilateral como causa rara de hiperaldosteronismo: relato de caso e revisão da literatura / Primary unilateral hyperplasia with hyperaldosteronism rare cause: case report and literature review

O hiperaldosteronismo primário é uma síndrome caracterizada pela excessiva produção de aldosterona pelo córtex das glândulas supra-renais, provocando expansão do volume vascular em associação à hipocalemia e alcalose metabólica.Tivemos como objetivo relatar um caso de hiperplasia primária unilateral como causa rara de hiperaldosteronismo. Além disso, realizamos uma revisão dos aspectos etiopatogênicos, diagnóstico e terapêutico dessa entidade clínica.