[Frequency of menstrual disturbances in gynecology and obstetrics residents]. / Frecuencia de trastornos menstruales en residentes de ginecología y obstetricia.

OBJECTIVE: To determine the frequency of menstrual disorders in gynecology and obstetrics residents. MATERIAL AND MET HODS: All residents of the 2015-2016 academic cycle were studied. In all them the menstrual cycle characteristics such as: rhythm, duration and quantity were analyzed. For statistical analysis Mann Whitney U test and Spearman's correlation analysis were done. RESULTS: 61 residents, 18 of 2nd, 21 of 3rd and 22 of 4th year were studied. Body mass index was significantly greater in those of 4th grade when compared with those of 2nd. The waist hip ratio (WHR) was significantly smaller in those of 3rd when compared with those of 4th. The reported frequency of menstrual disturbances was 22.8%, 28.6% and 22.7% for the 2nd, 3rd and 4th years respectively. After comparing the groups, between them the total volume was greater in those of 2nd when compared with those of 3rd (p<0.009) and 4th (p<0.04) In the correlation analysis in those of 2nd grade the WHR negatively correlated with the duration of bled (p <0.483, p<0.049). In those of 3rd year the WHR positively correlated with the duration (p 0.544, p<0.024) and with the total volume (p 0.553, p<0.02 1). In those of 4th year any correlation was found. CONCLUSION: The 2nd year residents women's are more likely to suffer menstrual disorders compared with those of 3rd and 4th ear of residence.

Endometrial changes according to hormone replacement therapy schedule.

OBJECTIVE: The purpose of this study was to assess differences in endometrial thickness, ultrasonographic characteristics, and histological and bleeding patterns in two groups of women according to the type and length of hormone replacement therapy (HRT) administered. DESIGN: Twenty-seven women were divided into two groups. Group I received oral conjugated estrogens 0.625 mg/day for 21 days, plus chlormadinone 2 mg the last 12 days, for a median length of 6.5 months' time. Group II received oral conjugated estrogens 0.625 mg/day plus chlormadinone 1 mg/day, both continuous and uninterrupted (n = 13), for a median length of 3 months' time. Using transvaginal ultrasound, endometrial thickness, refringence, and the presence of liquid in the uterine cavity were analyzed. An endometrial biopsy was performed the same day and the histological and bleeding patterns were described. Statistical analysis was performed with Mann-Whitney U test, Fisher's exact test, and Spearman correlation coefficient. RESULTS: Results of these tests showed that liquid in the uterine cavity and secretory endometrium were frequently found in those with sequential schedule (Group I); regular uterine bleeding was also frequent in this group. Negative correlation coefficients were found in this group between duration of HRT and endometrial thickness and uterine bleeding patterns, and in the continuous schedule group, between the duration of HRT and uterine bleeding pattern. CONCLUSIONS: We conclude that endometrial and ultrasonographic changes depend on the type of HRT schedule and the duration of therapy.

Incomplete regression of müllerian ducts in the androgen insensitivity syndrome.

The biochemical and histological features of two related patients with the complete form of the androgen insensitivity syndrome (AIS) coexisting with incomplete regression of the Müllerian ducts are described. Both patients presented unilateral Müllerian derivatives (fallopian tube) identified by microscopic examination of surgically excised internal genital tissue. Biochemical studies performed in genital skin-derived fibroblasts from one of the affected subjects showed the existence of a specific and saturable 8.2 to 8.4 S cytosolic and 3.4 S nuclear androgen receptor exhibiting a Kd of 1.32 nmol/L. These mutant cells, however, clearly presented a significantly low maximal nuclear [3H]-5 alpha-dihydrotestosterone uptake (71.0 fmol/mg of deoxyribonucleic acid [DNA]; control strain, 284 fmol/mg DNA). Thus, an impaired uptake of the androgen receptor complex at the nuclear level was probably the cause of the complete absence of phenotypic expression of androgen action in this family. The overall findings are on line with the well-demonstrated genetic and molecular heterogeneity of the AIS.

Recovery of ovarian function after childbirth, lactation and sexual activity with relation to age of women.

The time for recovery of ovulation, lactation and initiation of sexual intercourse after childbirth was studied in 90 women, who were divided into three groups: 1) adolescents less than 19 years old (n = 30); 2) younger mothers 19 to 32 years old (n = 30); and 3) older women more than 32 years old (n = 30). No differences were found in the duration of breast-feeding or in the initiation of sexual intercourse among the three groups. The postpartum amenorrhea in lactating women was significantly longer than in nonlactating mothers. The amenorrhea was significantly less in younger women than in older mothers and tended to be lower than in adolescents. The time between delivery and detection of ovulation was significantly longer in women who breast-fed than in those who did not. Furthermore, this time was significantly shorter in younger women than in older mothers. The present work suggests that younger women had a quicker recovery of ovarian function than adolescents and older women.

Influence of previous bilateral partial tubal resection on symptoms, hormones, lipids, and bone density in postmenopausal women.

The late effect of bilateral partial tubal resection (BPTR) on symptoms, hormone and lipid levels, and bone density in postmenopausal women was analyzed. Thirty-six postmenopausal women in whom BPTR was accomplished were studied; they were matched by age with a group without BPTR. They were subdivided according to time since BPTR into two groups: < or = 15 years > 15 years since the procedure. In both groups, the patients' general data were analyzed as well as the frequency of climacteric symptoms; serum levels of follicule-stimulating hormone (FSH), estradiol, total cholesterol, HDL-C, LDL-C, and triglycerides; and bone density in lumbar spine, femoral neck, Ward's triangle, and trochanter. The statistical analysis was done for the symptoms with chi-squared and for the rest of variables with Student's t-test. When comparing the groups, no differences were found in analyzed parameters; only hot flashes and sweating associated with hot flashes were frequently found in the BPTR group when the analysis was done in the group without any division. With the groups subdivided, hot flashes were found more frequently in the group for whom it had been more than 15 years since the BPTR procedure. The BPTR did not influence hormone and lipid levels or bone density.

The relation of the gonadotrophin response to chlormadinone according to body weight in patients with amenorrhea due to polycystic ovarian syndrome.

OBJECTIVE: To analyze the influence of weight on gonadotrophin response after chlormadinone (hydroxyprogesterone derivative) induced uterine bleeding in women with amenorrhea due to polycystic ovarian syndrome (PCOS). DESIGN: A comparative study. METHODS: Thirty-six patients with PCOS were classified according to body mass index into three weight groups, normal, overweight and obese. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels were measured during amenorrhea and between days 3-5 after a chlormadinone (2 mg/day for 5 days) induced uterine bleed. Statistical analysis was performed with Wilcox-on test for paired groups and Mann-Whitney U-test for independent groups. RESULTS: Overall LH, FSH levels and the LH/FSH ratio fell significantly (P < 0.001, P < 0.01 and P < 0.001, respectively) after chlormadinone administration. The LH levels decreased in all three weight groups, the LH/FSH ratio only fell in those normal and overweight subjects, and FSH did not change in any group. When comparing the group with normal weight and those with overweight and obesity no hormonal differences were found. CONCLUSION: These results show that chlormadinone has an inhibitory effect predominantly over LH secretion which reduces the LH/FSH ratio, but this is independent of body weight.

Neovagina with cultured allogenic epidermal sheets.

Several materials have been used in neovagina construction, but most of them show some kind of drawback. This is the report of a case in which cultured allogenic epidermal sheets were used instead of skin grafting for a McIndoe procedure.

Estrogen therapy for depression in postmenopausal women.

OBJECTIVE: To look at the modification in depressive mood in postmenopausal depressed women after estrogen replacement therapy (ERT). METHOD: Twelve depressed patients divided into two groups of six women each were studied. One group received conjugated equine estrogens (CEE) 0.625 mg/day; the other did not receive any treatment (control group). Mood was assessed in all the subjects at baseline and at 6 months with Hamilton Rating Scale score and considered as depression when it was > 15. Differences between groups were determined by Mann-Whitney U-test, and in each group between baseline and 6-month values with Wilcoxon test. RESULTS: The ERT group had a statistically significant decrease in depressive mood (21 vs. 13 points, P < 0.03), while in the control group no significant change was found. Final Hamilton scale scores were significantly lower (P < 0.05) in those under ERT, when compared with those in the control group. CONCLUSION: Depressive mood decreased after 6 months with CEE, so the prescription of ERT can be useful in postmenopausal women with depressive mood.

Prolactin secretion in molar and normal pregnancy.

OBJECTIVE: To describe the relation between PRL and hCG, T3, T4, fT4, TSH, E2 and P4 levels in normal pregnancies and those complicated with GTD. METHOD: Twenty women, 10 with normal pregnancy and 10 with molar pregnancy were studied. The differences between them and the relation between prolactin (PRL) and human chorionic gonadotropin (hCG), estradiol and thyroid hormones, thyroid stimulating hormone (TSH) and progesterone, was determined by Mann-Whitney U-test and Pearson's correlation coefficient, respectively. RESULTS: HCG, estradiol and thyroid hormones were higher in molar pregnancy, but PRL and progesterone were similar and TSH was lower in molar pregnancy. A negative correlation was found between PRL level and all the hormones in normal pregnancy, with the exception of TSH, and in molar pregnancy there was a positive correlation of PRL with all hormones. CONCLUSION: HCG, E2, T3, T4, fT4 levels were higher in the group with molar pregnancy. Differences in correlation analysis suggest different endocrine regulation mechanisms in molar and normal pregnancies.

Rokitansky syndrome and MURCS association--clinical features and basis for diagnosis.

OBJECTIVE: To describe 19 cases with Rokitansky syndrome, as well as their endocrine features, and other associated malformations. METHODS: Nineteen cases of utero-vaginal atresia are reported. Serum levels of luteinizing hormone, follicle stimulating hormone, prolactin, estradiol, and progesterone were measured. Genetic study was done by karyotype and X chromatin. Pelvic ultrasound was performed, and searches for associated urinary and bone malformations were done by intravenous pyelogram and spinal column X-rays, respectively. RESULTS: In all patients, mammary growth began between 9 and 12 years, and pubic hair growth between 11 and 14 years. Nine of them sought advice for primary amenorrhea, and 10 for difficulty in sexual intercourse. Thirteen patients had begun sexual activity, between 18 and 30 years of age; six of them had dyspareunia, and in four it was impossible to have sexual intercourse, but three reported satisfactory sexual relations. External genitalia were normal in all, vaginal length was between 0.5 and 7 cm, and in all ended in a blind pouch. On pelvic ultrasound, normal ovaries and absent uterus were delineated; only one had polycystic ovaries. All had a 46XX karyotype and positive X chromatin. Hormone levels were normal in 16, 3 had hyerprolactinemia. In 7 out of 11 in whom progesterone was measured, it was ovulatory. In 8 out of 11, the pyelogram was abnormal, and in the same number, skeletal anomalies were found. CONCLUSIONS: In three patients, MURCS association was documented. It is proposed as an easy and minimally invasive study protocol for diagnosis.

Influence of weight and body fat distribution on bone density in postmenopausal women.

OBJECTIVE: To determine whether obesity or body fat distribution induces a greater modification on bone remodeling biochemistry (BRB) and bone density in postmenopausal women. METHODS: One hundred and thirteen postmenopausal patients were studied. They were initially divided according to body mass index (BMI), and afterwards by waist-hip ratio (WHR) as well as combinations of the two factors. Hormone measurements and assessments of BRB were also done. Dual-emission X-ray absorptiometry from the lumbar column and hip was performed with Lunar DPXL equipment, and the standard deviation in relation to young adult (T) and age-matched subjects (Z) was calculated. Statistical analysis was done by the Mann-Whitney U test. The relation of BMI and WHR with the variables was calculated by simple regression analysis. RESULTS: When divided according to BMI, there was greater bone density in the femoral neck in those with normal weight. After dividing according to WHR, the Z scores had a trend to a lesser decrease in those with upper level body fat distribution. Divided according to BMI and WHR, obese patients with upper-level body fat distribution had greater bone density in the lumbar column than those with normal weight and lower-level body fat distribution. With the same WHR, those with normal weight had greater bone density than those who were obese. CONCLUSIONS: A beneficial effect of upper-level body fat distribution on bone density was found. It is greater than that from obesity alone, and obesity and upper-level body fat distribution have an additive effect on bone density.

Changes in symptoms, blood pressure, glucose, hormones, and lipid levels according to weight and body fat distribution in climacteric women.

OBJECTIVE: To evaluate how symptoms, blood pressure, glucose, hormones and lipid levels are modified in climacteric women according to obesity and body fat distribution. METHODS: One hundred and thirteen women were studied and divided initially according to body mass index (BMI), and afterward to waist-hip ratio (WHR). Climacteric symptoms, blood pressure, fasting and post-breakfast glucose, hormone and lipid levels were analyzed. Statistical analysis was done by the chi square and Mann-Whitney U tests, and the relation of BMI and WHR with several variables was assessed by linear regression analysis. RESULTS: When dividing patients according to BMI, the only differences were found in age, number of diabetic and hypertensive patients, and values of systolic and diastolic blood pressure, which were greater in the obese group. When dividing according to WHR it was found that high-density lipoproteins were lower in those with upper segment body fat distribution. Subgroup analysis showed that chronic diseases are frequently found in obese women, while android body fat distribution has an additive effect on obesity in some of these variables. CONCLUSION: Chronic diseases are more frequently found in obese women, but most of the metabolic alterations are modified by body fat distribution in the upper segment.

Changes in symptomatology, hormones, lipids, and bone density after hysterectomy.

OBJECTIVE: To evaluate the differences in symptoms, hormone and lipid levels, and bone density in two groups of women. METHODS: Two hundred eighty-five women who attended for climacteric study with previous simple hysterectomy were studied. Three groups were formed according to time since surgery (group I < 10 years, group II > or = 10 and < 20 years, and group III > or = 20 years). They were paired by age with a group without hysterectomy (control group) that also attended for climacteric study. None of them were receiving nor had received hormone replacement therapy. Age, body mass index, gestations, deliveries, and climacteric symptoms were analyzed for all subjects. Follicle-stimulating hormone (FSH), estradiol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were determined, and atherogenic index was calculated. Bone density was measured with a Lunar DPXL appliance. Statistical analysis was done by the chi-square test, Student's t test, and linear regression analysis. RESULTS: There were no differences among groups in body mass index, gestations, or deliveries. Depression was more frequent in the hysterectomy group, who also had lower levels of total cholesterol, HDL cholesterol, and FSH than controls. CONCLUSIONS: It was observed that hysterectomy does not have a deleterious effect on hormone or lipid levels, nor on bone density, but depression was a frequent finding in hysterectomized women.

Changes in symptoms, lipid and hormone levels after the administration of a cream with phytoestrogens in the Climacteric--preliminary report.

OBJECTIVE: To establish the changes in lipid and hormone levels, as well as in symptoms, after topical application of a cream with phytoestrogens in postmenopausal women. METHODS: 30 postmenopausal women were studied. At baseline and 1 month after the beginning of treatment, levels of FSH, estradiol, estrone, testosterone, androstenedione, dehydroepiandrosterone, total cholesterol, HDL-C, LDL-C, and triglycerides were measured. Climacteric symptoms were evaluated with a modified Kupperman's index (KI). The subjects received a cream with phytoestrogens (n = 15) or placebo (cold cream) (n = 15) in a randomized, double-blind manner. Statistically significant differences were determined by Student's t test. RESULTS: No differences were found in hormones, lipids, or in KI between the groups. When comparing each group separately, only a significant decrease in KI was found, in both groups, at the end of the treatment. CONCLUSIONS: This cream with phytoestrogens had an effect only in climacteric symptoms, but similar to the placebo. The lack of effect in the other variables was probably due to the administration route, or to a lack of effect of this product.

[Isosexual precocious puberty secondary to a subarachnoid cyst]. / Pubertad precoz isosexual secundaria a quiste subaracnoideo.

A new case of isosexual precocious puberty due to the presence of a subarachnoid cyst is reported. A female patient 16 months old was brought to our outpatient clinic because she had had two episodes of endometrial bleeding. Activity of the hypothalamic-pituitary-ovarian axis was demonstrated by pubertal concentrations of LH, FSH and estradiol. An arteriography and a CT demonstrated the presence of a subarachnoid cyst which was conditioning the pubertal process. Surgical resection of almost all the cyst, along with shunting, did not suppress endocrine activity. Suppressive treatment with medroxyprogesterone acetate was prescribed in order to accomplish the arrest of the pubertal process.

[Cancer of the colon and pregnancy]. / Cáncer de colon y embarazo.

In a woman 31 year old, with a 21 week pregnancy, an adenocarcinoma was found in transverse colon, it was excised; she received chemotherapy. At week 33, a healthy female baby was obtained by cesarean section. The patient died four months after the diagnosis. Estrogen receptors in colon tumor were negative.

[Cytological changes in the vagina following therapy with conjugated estrogens in relation to body weight and adipose tissue distribution in postmenopause]. / Cambios en la citología vaginal posteriores al tratamiento con estrógenos conjugados conforme al peso corporal y distribución del tejido adiposo en la posmenopausia.

Thirty women in which an abdominal hysterectomy has been done and with climacterical symptoms were studied in order to analyze which modification has the vaginal cytology according to body weight and body fat distribution after conjugated estrogen administration as hormone replacement therapy. Once divided according to weight it was found that there was an increase in estrogenic value (EV) in women with normal weight and in those with obesity. When divided according to body fat distribution only there was an increase in intermediate cells and in EV in the group with lower body fat distribution. These findings show that body fat distribution is more important than body weight over EV in women which are receiving estrogen replacement therapy.

[Vaginal reconstruction]. / Reconstrucción vaginal.

This article review the congenital vaginal absence, as well as the evolution of the different techniques to construct a neo vagina. Also the advantages and disadvantages of the most used actual techniques are discussed.

[Modification of the Abbe-Wharton-McIndoe technique using regenerated oxidized cellulose instead of a skin graft]. / Modificación a la técnica de Abbe-Wharton-McIndoe, utilizando celulosa oxidada regenerada en vez de injerto de piel.

Many conditions have an abnormal development of the vagina, which impair satisfactory sexual activity. Non-surgical and surgical procedures have been developed to correct this situation, the Abbe-Wharton-McIndoe operation is one with the best results, but it has the disadvantage that the scar produced in the place where the skin graft is taken has an awful appearance. Although the oxidized regenerated cellulose (ORC) has been extensively used in pelvic surgery to avoid or diminish the adhesion formation, no other uses have been described for this material; we decided to use ORC instead of skin graft at the moment of the Abbe-Wharton-McIndoe procedure, in order to achieve rapid epithelization of the recently created cavity and avoiding skin graft taken. This is the report of four cases with Rokitansky syndrome in which a vagina was created using the McIndoe procedure and ORC was used instead of skin graft. At 12 weeks after surgery a complete epithelization of the new open cavity was achieved with the presence of mature vaginal epithelium. The conclusion is that ORC is an alternative instead of skin graft, with the advantage of avoiding the skin graft taken as well as the scar obligatorily produced with that procedure, and also achieving a complete and quick epithelization of the new cavity.

[Modified factors in the study of the infertile couple in women with papilloma virus cervical infection, descriptive analysis]. / Factores alterados en el estudio de la pareja estéril en mujeres con infección cervical por virus del papiloma humano, análisis descriptivo.

The cervical infection by human papilloma virus (HPV) is considered one of the most common sexual transmitted diseases. Fifty couples were studied which consulted for sterility, in all women a cervical HPV infection was detected. Colposcopy, cervical biopsy, vaginal secretions culture, hysterosalpingography, laparoscopy and semen analysis were performed, in all of them. Age, obstetrical history, age at which patients began sexual relations, number of sexual partners, usage and time of usage of intrauterine device were analyzed. We can conclude that patients HPV cervical infection have risk factors for tuboperitoneal sterility, and are also in risk for other sexual transmitted diseases.