Estudios ultrasonográficos diagnósticos y de control de los ciclos en reproducción asistida / No disponible

No disponible

Dolor pélvico de origen ginecológico como patología urgente / Gynecological pelvic pain as emergency pathology

El dolor pélvico agudo es una causa frecuente de consulta en los servicios de urgencias. Los síntomas inespecíficos hacen que a menudo se encuentre patología ginecológica en pacientes remitidas por otras sospechas diagnósticas. Por eso es importante familiarizarse con este tipo de patología y ser capaces de identificar sus hallazgos más representativos. El objetivo de este artículo es revisar las principales causas del dolor pélvico agudo de origen ginecológico, aportando datos clave que permitan establecer un diagnóstico acertado y orientar el tratamiento adecuado (AU)

Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management (AU)

Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all.

OBJECTIVE: To identify factors associated with cancer treatment-induced amenorrhea and time to return of menses. DESIGN: Population-based cohort study. SETTING: Not applicable. PATIENT(S): Female cancer survivors who were diagnosed with cancer between the ages of 20 and 35 and were at least 2 years postdiagnosis at the time of recruitment (median = 7 years; interquartile range, 5-11). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Amenorrhea (≥6 months without menses) and resumption of menses. RESULT(S): After excluding women with hysterectomies before cancer diagnosis, 1,043 women were eligible for analysis. Amenorrhea occurred in 31.6% of women. Among women treated with chemotherapy (n = 596), older age at diagnosis (30-35 vs. 20-24 years: adjusted odds ratio [aOR] = 2.37; 95% confidence interval [CI], 1.30, 4.30) and nulligravidity (vs. gravid: aOR = 1.50; 95% CI, 1.02, 2.21) were risk factors for amenorrhea. Among amenorrheic women, menses resumed in most (70.0%), and resumption occurred within 2 years of treatment for 90.0% of women. Survivors of breast cancer were more likely to resume menses at times greater than 1 year compared with lymphoma and pelvic-area cancers. Women diagnosed at older ages, those exposed to chemotherapy, and those exposed to any radiation experienced longer times to return of menses. Women who were older at diagnosis were more likely to have irregular cycles when menses returned. CONCLUSION(S): Treatment-induced amenorrhea is common in cancer survivors, although most women resume menses within 2 years. However, once resumed, older women are more likely to have irregular cycles. Age at diagnosis and pregnancy history affect the risk of amenorrhea.

Mutagenic effects of ionizing radiation on immature rat oocytes.

Estimates of genetic risks from radiation delivered to humans are derived largely from mouse studies. In males, the target is spermatogonia and a large amount of information is available. In contrast, in females, immature oocytes are the target, but extrapolations from mice to humans are not very definitive because immature mouse oocytes are highly sensitive to radiation and die by apoptosis, which is not the case in humans. Since mouse offspring derived from surviving immature oocytes have to date not shown any signs of mutation induction, two alternative hypotheses are proposed: 1. Apoptotic death effectively eliminates damaged oocytes in mice and therefore human immature oocytes may be highly mutable; and 2. Immature oocytes are inherently resistant to mutation induction and apoptotic death is not relevant to mutagenesis. To test these hypotheses, rat immature oocytes, which are not as sensitive as those in mice to radiation-induced apoptosis were exposed to 2.5 Gy of gamma rays and the offspring were examined using a two-dimensional DNA analysis method. Screening of a total of 2.26 million DNA fragments, we identified 32 and 18 mutations in the control and exposed groups, respectively. Of these, in the two groups, 29 and 14 mutations were microsatellite mutations, two and one were base changes, and one and three were deletions. Among the four deletions most relevant to radiation exposure, only one was possibly derived from the irradiated dam (but not determined) and three were paternal in origin. Although the number of mutations was small, the results appear to support the second hypothesis and indicate that immature oocytes are generally less sensitive than mature oocytes to mutation induction.

Shortening of the menstrual cycle following light therapy in seasonal affective disorder.

A significantly earlier onset of menstruation by 1.2 days, on average, was found following light therapy in 38 winter depressives; in two of them it could be classified as a minor side effect. There was no association between this shortening and depression improvement. A direct action of light on the hypothalamic-pituitary-gonadal axis is suggested.

Radiation-induced micronucleus frequencies in female peripheral blood lymphocytes collected during the first and second half of the menstrual cycle.

Biological dosimetry relies on the assessment of dose in peripheral blood lymphocytes (PBL) of a victim. Variability in the individual radiosensitivity of PBL has an impact on the precision of dose estimate and radiation-induced micronuclei show a strong individual variability. A factor which can influence the radiosensitivity of PBL is the hormonal status of female donors, which shows a regular pattern during the menstrual cycle. The aim of the present investigation was to verify whether the position within the menstrual cycle has an impact on the level of micronuclei in PBL. Blood was collected from 19 donors during the first and second half of the menstrual cycle and exposed to 2 Gy. Although statistically significant differences between the MN frequencies in PBL collected during the different time points were observed in the case of some donors, no reproducible trend that could find application in biological dosimetry could be detected.

Menstrual cycle disorders after therapy with iodine-131.

OBJECTIVE: To investigate any abnormalities of the menstrual cycle and/or pregnancy in women <40 years old who had received radioiodine (I-131) therapy for thyroid cancer. DESIGN: Case-control study. SETTING: General military hospital in Athens, Greece. PATIENT(S): Forty-five women of childbearing age with thyroid cancer that were treated with I-131 from December 1996 to May 2003 were compared to 83 age-matched control females. INTERVENTION(S): The patients' charts were reviewed, and in addition patients were contacted by telephone and asked detailed questions about their previous gynecologic history and any problems after treatment (menstrual cycle and pregnancy). MAIN OUTCOME MEASURE(S): Abnormalities of menstrual cycle and/or pregnancy. RESULT(S): Overall, 14 of 45 women (31.1%) had menstrual cycle irregularities after treatment. Eight patients (17.8%) had normal menstrual cycles before therapy and six (13.3%) had pretreatment menstrual cycle irregularities that persisted or were exaggerated after therapy. In the control group, 12 of 83 women (14.5%) reported menstrual cycle irregularities. The patients' menstrual cycle and menses irregularities were significantly increased after I-131 therapy (P=.02) compared with the control group and seemed to increase with age. After therapy a total of seven children were borne by 6 of the 45 patients (13.3%). No premature births or miscarriages were noted. CONCLUSION(S): The study found a significant increase of patients with menstrual cycle and/or menses irregularities after treatment with I-131. However, therapy with I-131 did not result in any subsequent pregnancy abnormalities such as premature births or miscarriages.

Transcallosal inhibition across the menstrual cycle: a TMS study.

OBJECTIVE: To determine if there are steroid-dependent changes in transcallosal transfer during the menstrual cycle in normal women. METHODS: We tested 13 normally cycling women during the menstrual, follicular and midluteal phases. Blood levels of estradiol (E) and progesterone (P) were determined by radioimmunoassay. Ipsilateral tonic voluntary muscle activity suppression, called ipsilateral silent period (iSP), was evoked by applying transcranial magnetic stimulation (TMS) over the left motor cortex and by measuring the EMG of the ipsilateral first dorsal interosseus (FDI) muscle. Both iSP-duration and transcallosal conduction times were measured and related to cycle phase and steroid levels. RESULTS: Duration of iSPs varied over the cycle with largest differences between follicular and midluteal phases. During the midluteal phase high levels of P were significantly related to short iSPs. This relation also applied to E levels and iSPs during the follicular phase. CONCLUSIONS: Our study shows for the first time that the transcallosal transfer is modulated by E and P and changes over the menstrual cycle. SIGNIFICANCE: It is suggested that gonadal steroid hormones affect the interhemispheric interaction and change the functional cerebral organization sex dependently via its neuromodulatory properties on GABAergic and glutamatergic neurons.

Ovarian function after radioiodine therapy in patients with thyroid cancer.

OBJECTIVE: To assess ovarian function in young women treated with radioiodine. METHODS: The study was conducted on 50 women with thyroid carcinoma aged less than 40 years (mean, 29.8 years), with regular menstrual cycles and normal FSH levels prior to radioiodine therapy. FSH determination was repeated 6 and 12 months after radioiodine therapy (mean, 4.24 GBq iodine-131) and menstrual cycles were monitored during this period. RESULTS: Twenty percent of the patients reported amenorrhea during the first year. FSH levels increased after 6 months (from 5.1 +/- 1.8 to 10.6 +/- 2.2 IU/l, p < 0.00 001) and 28 % of the patients showed elevated values, which had returned to normal by the end of the first year. CONCLUSION: Radioiodine causes transitory alterations in ovarian function even in younger women and after a mean activity of 4.2 GBq (115 mCi).

[The correction of the immunohormonal disorders in patients with hyperplastic processes in the endometrium]. / Korrektsiia immunogormonal'nykh narushenii u bol'nykh s giperplasticheskimi protsessami v éndometrii.

Effects were studied of extremely high-frequency electromagnetic radiation (EHF ER) on indices for the immune and endocrine systems in 48 patients with hyperplastic processes in the endometrium. It is ascertain that along with the established normalization of parameters characterizing the above systems there occurs a return of correlations back to normal, which fact permits using EHF ER as an immunocorrective factor.

[The correction of immunoendocrine disorders in patients with hyperplastic processes in the endometrium]. / Korrektsiia immunoéndokrinnykh narushenii u bol'nykh s giperplasticheskimi protsessami v éndometrii.

Effects were studied of extremely high-frequency electromagnetic radiation (EHF EMR) on indices for the immune and endocrine systems in a series of 48 patients presenting with hyperplastic processes in endometrium. EHF EMR-related normalization of values for the above systems was found out to take place together with a return of correlations back to normal, which fact makes it possible to use this modality as an immunocorrective factor.

[Significance of occupational factors for women's fertility and menstrual cycles]. / Arbejdsmiljøfaktorers betydning for kvinders frugtbarhed og menstruationsforhold.

Reduced fertility is frequent, reflected by the fact that 15% of all couples desiring pregnancy try for more than one year without achieving it. Women at work are often exposed to chemical or physical agents, some of which are carcinogenic or teratogenic. Fertility seems to be affected by exposure to lead, mercury, solvents, textile dyes, noise and some pesticides. The purpose of this paper is to summarize the current knowledge of the relations between fertility, menstrual irregularity and occupational exposures. There are still some methodological problems to be solved in relation to fertility. Waiting time to pregnancy seems to be an appropriate measure of fertility. The full distribution of time to pregnancy over months or menstrual cycles should be used in the analysis.

Night light alters menstrual cycles.

Dewan asserted 20 years ago that a bedside light could shorten and regularize the menstrual cycle among women with long and irregular menstrual patterns. To replicate this, seven volunteers slept with a 100-watt bulb by the bedside from days 13-17 of their menstrual cycles, while nine controls similarly used a dim red placebo (photographic safe light). Indeed, the 100-watt bulbs shortened menstrual cycles from a mean of 45.7 days to 33.1 days and reduced variability, but the placebo had no effect. These results suggest that light may have promise for treatment of infertility, for contraception, and for other endocrine interventions.

Lateral high abdominal ovariopexy: an original surgical technique for protection of the ovaries during curative radiotherapy for Hodgkin's disease.

An original surgical method for gonadal protection in young women given pelvic radiation for Hodgkin's disease is presented. Lateral high ovarian transposition (LHAO) consists of the transposition of the ovaries into the paracolic gutter during staging laparotomy, after disconnecting the gonads from the fallopian tubes by dividing the tubo-ovarian vessels. The technique's effectiveness was assessed by a study using clinical investigation, radioimmunoassay (RIA) determination of sex hormones, and dosimetry; of 18 patients treated, 10 participated in the study. All but one have normal menses and hormone values, and one pregnancy occurred. We also calculated the doses absorbed by the ovaries and proved that, during inverted Y irradiation following LHAO, the ovaries are exposed to nearly one-half the dose they receive after traditional medial transposition. During subtotal nodal irradiation after LHAO, the irradiation dose is higher than after medialisation, but absolute values are minimal and castration is not induced.